Provider Demographics
NPI:1942867247
Name:SYNERGY PHYSICAL THERAPY AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAFFY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEARES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:870-571-4002
Mailing Address - Street 1:3494A SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3560
Mailing Address - Country:US
Mailing Address - Phone:870-571-4002
Mailing Address - Fax:903-306-2570
Practice Address - Street 1:3494A SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3560
Practice Address - Country:US
Practice Address - Phone:870-571-4002
Practice Address - Fax:903-306-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401273401Medicaid