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General NPI Number Information
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NPI Number | 1962695411
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Entity Type | Organization
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Legal Business Name | SYNERGY PT & ATHLETIC PERFORMANCE,LLC
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Dates
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Enumeration Date | 08/18/2007
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 4720 PUDDLEDOCK RD STE 130
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1275
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Country | US
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Telephone | 804-520-7779
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Fax | 866-463-3074
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Provider Business Mailing Address
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Address Line | 4720 PUDDLEDOCK RD SUITE 130
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-1275
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Country | US
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Telephone | 804-520-7779
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Fax | 866-463-3047
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIAN DALE WHEELER
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Credential | MPT, DPT, CSCS
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Telephone | 804-520-7779
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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 | 2305202615
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License Number State | VA
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