Provider Demographics
NPI:1972142768
Name:SYNERGY AQUATIC THERAPY INC
Entity Type:Organization
Organization Name:SYNERGY AQUATIC THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:559-323-4100
Mailing Address - Street 1:7005 N CHESTNUT AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0348
Mailing Address - Country:US
Mailing Address - Phone:559-323-4100
Mailing Address - Fax:
Practice Address - Street 1:7005 N CHESTNUT AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0348
Practice Address - Country:US
Practice Address - Phone:559-323-4100
Practice Address - Fax:559-323-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty