Provider Demographics
NPI:1922711878
Name:SYNERGY PHYSICAL THERAPY & PERFORMANCE III, LLC
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY & PERFORMANCE III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DYSART
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:504-782-2728
Mailing Address - Street 1:513 DILTON ST
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1232
Mailing Address - Country:US
Mailing Address - Phone:504-782-2728
Mailing Address - Fax:
Practice Address - Street 1:2613 NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6306
Practice Address - Country:US
Practice Address - Phone:504-782-2728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy