Healthcare Provider Details

I. General information

NPI: 1902032998
Provider Name (Legal Business Name): SYNERGY MANUAL PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 21ST ST SUITE 130
COLORADO SPRINGS CO
80904-3702
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-634-1110
  • Fax: 719-634-1112
Mailing address:
  • Phone: 719-634-1110
  • 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