MEDICARE: SYNERJE LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1649987108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYNERJE LLC

Provider Business Mailing Address
First Line	:	211 HIGHWAY 17 N STE 201
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8107
Country	:	US
Telephone Number	:	843-489-0788
Fax Number	:	844-444-0570

Provider Business Practice Location Address
First Line	:	211 HIGHWAY 17 N STE 201
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-8107
Country	:	US
Telephone Number	:	843-489-0788
Fax Number	:	844-444-0570

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	SHANNON WILLOUGHBY
Credential	:	LMT
Telephone Number	:	843-489-0788

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	02/23/2024

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Directions to “SYNERJE LLC ” Practice Location

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