Provider Demographics
NPI:1376569004
Name:SYNERGY PROFESSIONAL HEALTHCARE INC.
Entity Type:Organization
Organization Name:SYNERGY PROFESSIONAL HEALTHCARE INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:402-201-7201
Mailing Address - Street 1:4835 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2002
Mailing Address - Country:US
Mailing Address - Phone:402-731-2291
Mailing Address - Fax:402-731-2291
Practice Address - Street 1:4835 S 49TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2002
Practice Address - Country:US
Practice Address - Phone:402-731-2291
Practice Address - Fax:402-731-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========OtherTAX ID#