Provider Demographics
NPI:1073601670
Name:SYNERGY PHYSICAL THERAPY OF ODESSA LP
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY OF ODESSA LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:432-335-8777
Mailing Address - Street 1:808 TOWER DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4243
Mailing Address - Country:US
Mailing Address - Phone:432-335-8777
Mailing Address - Fax:432-335-8787
Practice Address - Street 1:808 TOWER DR
Practice Address - Street 2:SUITE 7
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4243
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:432-335-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177897901Medicaid
TX454869Medicare PIN