Provider Demographics
NPI:1073658811
Name:SYNERGY PHYSICAL THERAPY AND REHAB, INC
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY AND REHAB, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRUTI
Authorized Official - Middle Name:AMIT
Authorized Official - Last Name:SANGHVI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:734-837-9673
Mailing Address - Street 1:46743 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4298
Mailing Address - Country:US
Mailing Address - Phone:734-837-9673
Mailing Address - Fax:734-981-8062
Practice Address - Street 1:46743 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-4298
Practice Address - Country:US
Practice Address - Phone:734-837-9673
Practice Address - Fax:734-981-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty