Provider Demographics
NPI:1114365756
Name:SYNERGY SPORTS & ORTHOPEDIC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SYNERGY SPORTS & ORTHOPEDIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIAPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:484-686-1484
Mailing Address - Street 1:365 LANCASTER AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1867
Mailing Address - Country:US
Mailing Address - Phone:484-686-1484
Mailing Address - Fax:
Practice Address - Street 1:365 LANCASTER AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1867
Practice Address - Country:US
Practice Address - Phone:484-686-1484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011753L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty