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General NPI Number Information
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NPI Number | 1538323324
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Entity Type | Organization
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Legal Business Name | SYNERGY PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/11/2008
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 3425 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67203-4919
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Country | US
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Telephone | 316-946-0990
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Fax | 316-943-1139
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Provider Business Mailing Address
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Address Line | 3425 W CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67203-4919
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Country | US
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Telephone | 316-946-0990
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Fax | 316-943-1139
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. CHARLES EDWARD LAVACEK
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Credential | P.T.
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Telephone | 316-461-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-02548
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License Number State | KS
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