Healthcare Provider Details

I. General information

NPI: 1659393411
Provider Name (Legal Business Name): SYNERGY THERAPEUTIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CEDAR CT
CARBONDALE IL
62901-5300
US

IV. Provider business mailing address

1110 CEDAR CT
CARBONDALE IL
62901-5300
US

V. Phone/Fax

Practice location:
  • Phone: 618-243-7822
  • Fax: 618-529-4560
Mailing address:
  • Phone: 618-243-7822
  • Fax: 618-529-4560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHANDANA DASH
Title or Position: THERAPIST
Credential: OTRL
Phone: 618-529-4360