1497089080 NPI number — SYNERGY PHYSICAL THERAPY AND YOGA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497089080 NPI number — SYNERGY PHYSICAL THERAPY AND YOGA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY PHYSICAL THERAPY AND YOGA, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497089080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2942 EVERGREEN PKWY
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80439-7909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-568-9905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2942 EVERGREEN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERGREEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-917-5575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
303-568-9905

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  7904 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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