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General NPI Number Information
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NPI Number | 1578936167
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Entity Type | Organization
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Legal Business Name | SYNERGY PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 400 ROUTE 211 E SUITE 12
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2122
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Country | US
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Telephone | 201-957-5864
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ROUTE 211 E SUITE 12
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City | MIDDLETOWN
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State | NY
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Zip | 10940-2122
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Country | US
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Telephone | 201-957-5864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KISHORE KANDURI
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Credential | MR
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Telephone | 201-957-5864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 015851
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License Number State | NY
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