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General NPI Number Information
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NPI Number | 1164223749
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Entity Type | Organization
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Legal Business Name | SYNOVA WOUND CARE
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 7100 FAIRWAY DR STE 42
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-3778
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Country | US
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Telephone | 561-310-7259
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Fax | 561-516-7357
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Provider Business Mailing Address
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Address Line | 5656 BEE CAVES RD
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City | WEST LAKE HILLS
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State | TX
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Zip | 78746-5280
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Country | US
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Telephone | 561-310-7259
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Fax | 561-516-7357
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Authorized Official
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Title or Position | OWNER
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Name | GABRIEL LEWIS PETTY
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Credential |
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Telephone | 512-745-3037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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