Healthcare Provider Details

I. General information

NPI: 1154454122
Provider Name (Legal Business Name): SYNERGY REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MILLBROOK VILLAGE DR SUITE C
TYRONE GA
30290-3603
US

IV. Provider business mailing address

PO BOX 476
TYRONE GA
30290-0476
US

V. Phone/Fax

Practice location:
  • Phone: 678-364-9412
  • Fax: 678-364-9413
Mailing address:
  • Phone: 678-364-9412
  • Fax: 678-364-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRANTON RICE QUEEN
Title or Position: OWNER
Credential: PT
Phone: 678-364-9412