Provider Demographics
NPI:1942217047
Name:SYNERGY PHYSICAL THERAPY, LTD
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:847-680-1216
Mailing Address - Street 1:1216 AMERICAN WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3938
Mailing Address - Country:US
Mailing Address - Phone:847-680-1216
Mailing Address - Fax:847-680-1209
Practice Address - Street 1:1216 AMERICAN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3938
Practice Address - Country:US
Practice Address - Phone:847-680-1216
Practice Address - Fax:847-680-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00403794Medicare PIN