Healthcare Provider Details

I. General information

NPI: 1740697440
Provider Name (Legal Business Name): SYNERGY MANUAL PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 TELSTAR DR STE 115
COLORADO SPRINGS CO
80920-1029
US

IV. Provider business mailing address

2375 TELSTAR DR STE 115
COLORADO SPRINGS CO
80920-1029
US

V. Phone/Fax

Practice location:
  • Phone: 719-282-2320
  • Fax: 719-282-2330
Mailing address:
  • Phone: 719-282-2320
  • Fax: 719-634-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RIC WEGRZYN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-633-3479