Provider Demographics
NPI:1659393411
Name:SYNERGY THERAPEUTIC GROUP
Entity Type:Organization
Organization Name:SYNERGY THERAPEUTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUBRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHINIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-542-8950
Mailing Address - Street 1:412 S 34TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6021
Mailing Address - Country:US
Mailing Address - Phone:618-244-2213
Mailing Address - Fax:618-244-2119
Practice Address - Street 1:412 S 34TH ST STE 201
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-6021
Practice Address - Country:US
Practice Address - Phone:618-244-2213
Practice Address - Fax:618-244-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty