Provider Demographics
NPI:1851864557
Name:SYNERGIST, LLC
Entity Type:Organization
Organization Name:SYNERGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAIERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:563-543-4049
Mailing Address - Street 1:9498 GINGER DR
Mailing Address - Street 2:
Mailing Address - City:PEOSTA
Mailing Address - State:IA
Mailing Address - Zip Code:52068-8088
Mailing Address - Country:US
Mailing Address - Phone:563-543-4049
Mailing Address - Fax:
Practice Address - Street 1:1082 CEDAR CROSS RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7745
Practice Address - Country:US
Practice Address - Phone:563-543-4049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty