Healthcare Provider Details

I. General information

NPI: 1205693140
Provider Name (Legal Business Name): SYNTRILLO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 FOX RUN LN
CHARLOTTESVILLE VA
22901-8833
US

IV. Provider business mailing address

240 W MAIN ST STE 100CW113
CHARLOTTESVILLE VA
22902-5005
US

V. Phone/Fax

Practice location:
  • Phone: 770-301-2069
  • Fax:
Mailing address:
  • Phone: 678-508-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. OMAR URIBE
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 678-508-1130