Provider Demographics
NPI:1790193159
Name:SYNERGY MANUAL PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SYNERGY MANUAL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEGRZYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-633-3479
Mailing Address - Street 1:2375 TELSTAR DR STE 115
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1029
Mailing Address - Country:US
Mailing Address - Phone:719-282-2320
Mailing Address - Fax:719-634-1112
Practice Address - Street 1:104 PRO RODEO DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2334
Practice Address - Country:US
Practice Address - Phone:719-599-7770
Practice Address - Fax:719-599-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty