Healthcare Provider Details

I. General information

NPI: 1447917653
Provider Name (Legal Business Name): THE SYNOLYST CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/13/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17591 S DIXIE HWY
PALMETTO BAY FL
33157-5435
US

IV. Provider business mailing address

10383 SW 186TH ST
CUTLER BAY FL
33157-6824
US

V. Phone/Fax

Practice location:
  • Phone: 305-916-1256
  • Fax: 305-489-7795
Mailing address:
  • Phone: 786-560-9069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN A RODRIGUEZ
Title or Position: OWNER
Credential: PA, EDD
Phone: 305-916-1256