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General NPI Number Information
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NPI Number | 1780194266
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Entity Type | Organization
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Legal Business Name | SYNERGY AQUATIC AND LAND THERAPY LLC
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 1580 HIGHWAY 287 N
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City | MANSFIELD
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State | TX
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Zip | 76063-7593
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Country | US
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Telephone | 682-203-8735
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Fax | 682-205-8670
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Provider Business Mailing Address
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Address Line | 2408 TIMBERLOCH PLACE SUITE A-4
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City | THE WOODLANDS
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State | TX
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Zip | 77380-0000
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Country | US
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Telephone | 682-205-8735
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Fax | 682-205-8670
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Authorized Official
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Title or Position | OWNER
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Name | AARON BLICK
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Credential | MD
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Telephone | 682-205-8735
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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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