Healthcare Provider Details

I. General information

NPI: 1992256671
Provider Name (Legal Business Name): SYNERGY FITNESS & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 ESTATE SMITH BAY SUITE 334-335, BOX 5
ST THOMAS VI
00802-1324
US

IV. Provider business mailing address

6115 ESTATE SMITH BAY SUITE 334-335, BOX 5
ST THOMAS VI
00802-1324
US

V. Phone/Fax

Practice location:
  • Phone: 340-714-2348
  • Fax:
Mailing address:
  • Phone: 340-714-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVI

VIII. Authorized Official

Name: BONNIE JEAN O'ROURKE-BARR
Title or Position: OWNER
Credential: PT
Phone: 340-714-2348