Provider Demographics
NPI:1528369311
Name:SYNERGY PHYSICAL THERAPY REHABILITATION NETWORK, INC.
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY REHABILITATION NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SCATES
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS, DPT
Authorized Official - Phone:877-600-6847
Mailing Address - Street 1:1933 BANYON CMN
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4787
Mailing Address - Country:US
Mailing Address - Phone:877-600-6847
Mailing Address - Fax:925-245-0334
Practice Address - Street 1:15405 LOS GATOS BLVD
Practice Address - Street 2:SUITE #101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2500
Practice Address - Country:US
Practice Address - Phone:877-600-6847
Practice Address - Fax:925-245-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27031261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy