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General NPI Number Information
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NPI Number | 1699259432
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Entity Type | Organization
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Legal Business Name | SYNERGY PHYSICAL THERAPY & PERFORMANCE
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 1827 HICKORY AVE STE B
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City | HARAHAN
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State | LA
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Zip | 70123-5613
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Country | US
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Telephone | 504-782-2439
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Fax |
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Provider Business Mailing Address
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Address Line | 1827 HICKORY AVE STE B
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City | HARAHAN
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State | LA
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Zip | 70123-5613
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Country | US
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Telephone | 504-782-2439
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Fax |
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Authorized Official
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Title or Position | OWENER
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Name | CHRISTOPHER A DYSART
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Credential | DPT
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Telephone | 504-782-2439
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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 |
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License Number State |
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