Healthcare Provider Details

I. General information

NPI: 1649715111
Provider Name (Legal Business Name): SYNERGY REHAB OT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ORONOQUE LN # 303
STRATFORD CT
06614-1379
US

IV. Provider business mailing address

56 PARTRIDGE DR
SOUTHINGTON CT
06489-4017
US

V. Phone/Fax

Practice location:
  • Phone: 203-979-9440
  • Fax: 866-232-5535
Mailing address:
  • Phone: 203-979-9440
  • Fax: 866-232-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number001680
License Number StateCT

VIII. Authorized Official

Name: YURI VIGDORCHIK
Title or Position: PARTNER
Credential:
Phone: 203-430-6735