Healthcare Provider Details

I. General information

NPI: 1518538685
Provider Name (Legal Business Name): SYNERGY HEALTHCARE FOR KIDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6270 N GOVERNMENT WAY
DALTON GARDENS ID
83815-9214
US

IV. Provider business mailing address

12012 E MISSION AVE
SPOKANE VALLEY WA
99206-4887
US

V. Phone/Fax

Practice location:
  • Phone: 208-666-0611
  • Fax: 208-664-0566
Mailing address:
  • Phone: 509-263-9688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA D BURCHETT
Title or Position: OWNER/PRESIDENT
Credential: OTR/L
Phone: 509-263-9688