Healthcare Provider Details

I. General information

NPI: 1083922470
Provider Name (Legal Business Name): SYNERGY REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 WASHINGTON AVE SUITE 4
NORTH HAVEN CT
06473-1724
US

IV. Provider business mailing address

1125 W WOODS RD UNIT 17
HAMDEN CT
06518-1774
US

V. Phone/Fax

Practice location:
  • Phone: 203-691-0961
  • Fax:
Mailing address:
  • Phone: 203-691-0961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5614
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5614
License Number StateCT

VIII. Authorized Official

Name: RALPH LAUDANO MAURIELLO
Title or Position: SOLE MEMBER
Credential: PT
Phone: 203-691-0961