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General NPI Number Information
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NPI Number | 1649502881
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Entity Type | Organization
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Legal Business Name | SYNERGY PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 10657 165TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-5670
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Country | US
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Telephone | 952-435-0343
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Fax | 952-435-0344
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Provider Business Mailing Address
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Address Line | 10657 165TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-5670
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Country | US
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Telephone | 952-435-0343
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Fax | 952-435-0344
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL ALLEN HOLMQUIST
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Credential | BSPT
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Telephone | 952-435-0343
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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 | 3080
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License Number State | MN
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