Provider Demographics
NPI:1083922470
Name:SYNERGY REHABILITATION LLC
Entity Type:Organization
Organization Name:SYNERGY REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:LAUDANO
Authorized Official - Last Name:MAURIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-691-0961
Mailing Address - Street 1:1125 W WOODS RD
Mailing Address - Street 2:UNIT 17
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1774
Mailing Address - Country:US
Mailing Address - Phone:203-691-0961
Mailing Address - Fax:
Practice Address - Street 1:52 WASHINGTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1724
Practice Address - Country:US
Practice Address - Phone:203-691-0961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5614225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty