Provider Demographics
NPI:1508261470
Name:SYNTHESIS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SYNTHESIS PHYSICAL THERAPY
Other - Org Name:DIVINE PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWASEYI
Authorized Official - Middle Name:
Authorized Official - Last Name:OJOFEITIMI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-504-1328
Mailing Address - Street 1:322 W 52ND ST
Mailing Address - Street 2:#199
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10101-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 W 52ND ST
Practice Address - Street 2:#199
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10101-9401
Practice Address - Country:US
Practice Address - Phone:646-504-1328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023255261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy