Provider Demographics
NPI:1275093015
Name:SYNNESTVEDT, GREGORY ROBER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ROBER
Last Name:SYNNESTVEDT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 FERRY RD UNIT 601
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2391
Mailing Address - Country:US
Mailing Address - Phone:215-489-3234
Mailing Address - Fax:215-489-0131
Practice Address - Street 1:1456 FERRY RD UNIT 601
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-2391
Practice Address - Country:US
Practice Address - Phone:215-489-3234
Practice Address - Fax:215-489-0131
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027597225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT027597OtherLICENSE