Provider Demographics
NPI:1467448936
Name:SYNERGY ORTHOTICS AND PROSTHESTICS LLC
Entity Type:Organization
Organization Name:SYNERGY ORTHOTICS AND PROSTHESTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:972-769-8344
Mailing Address - Street 1:PO BOX 260756
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-0756
Mailing Address - Country:US
Mailing Address - Phone:972-769-8344
Mailing Address - Fax:972-769-0644
Practice Address - Street 1:1220 N. COIT RD
Practice Address - Street 2:102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7757
Practice Address - Country:US
Practice Address - Phone:972-769-8344
Practice Address - Fax:972-769-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101230332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011068601Medicaid
TX011068601Medicaid