MEDICARE: SYNOVA WOUND CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1164223749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNOVA WOUND CARE

Provider Business Mailing Address
First Line	:	5656 BEE CAVES RD
Second Line	:
City	:	WEST LAKE HILLS
State	:	TX
Zip	:	78746-5280
Country	:	US
Telephone Number	:	561-621-1501
Fax Number	:	561-516-7357

Provider Business Practice Location Address
First Line	:	7100 FAIRWAY DR STE 42
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3778
Country	:	US
Telephone Number	:	561-621-1501
Fax Number	:	561-516-7357

Authorized Official
Title or Position	:	OWNER
Name	:	GABRIEL LEWIS PETTY
Credential	:
Telephone Number	:	512-745-3037

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	04/29/2026

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