1790429728 NPI number — SYNERGY REHAB AND WELLNESS, BUENA VISTA

Table of content: MADISON ELIZABETH KANITZ (NPI 1497435598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790429728 NPI number — SYNERGY REHAB AND WELLNESS, BUENA VISTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNERGY REHAB AND WELLNESS, BUENA VISTA
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:
6
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:
1790429728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 BEECH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUENA VISTA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24416-3101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2275 BEECH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUENA VISTA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24416-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-416-0530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BRINKLEY
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
FLANDERS
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
540-416-0110

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com