Healthcare Provider Details

I. General information

NPI: 1669696704
Provider Name (Legal Business Name): SYZYGY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 S HAMPTON RD
DALLAS TX
75208-5621
US

IV. Provider business mailing address

516 SOUTH HAMPTON ROAD
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-0002
  • Fax: 214-941-0381
Mailing address:
  • Phone: 214-941-0002
  • Fax: 214-941-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number111742
License Number StateTX

VIII. Authorized Official

Name: MR. JARROD M ROGERS
Title or Position: PRESIDENT CEO
Credential:
Phone: 214-370-0404