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General NPI Number Information
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NPI Number | 1083058721
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Entity Type | Organization
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Legal Business Name | SYNERGY ORTHOTICS & PROSTHETICS, LLC
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 44790 MAYNARD SQ STE 240
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City | ASHBURN
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State | VA
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Zip | 20147-6514
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Country | US
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Telephone | 571-442-8514
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Fax | 571-442-8519
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Provider Business Mailing Address
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Address Line | 44790 MAYNARD SQ STE 240
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City | ASHBURN
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State | VA
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Zip | 20147-6514
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Country | US
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Telephone | 571-442-8514
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Fax | 571-442-8519
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Authorized Official
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Title or Position | OWNER/ PRACTITIONER
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Name | JOHNNY EMMANUEL BASKIN
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Credential | CP
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Telephone | 703-209-3790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CP03073
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License Number State | VA
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