Provider Demographics
NPI:1649341223
Name:SYNERGY REHAB MANAGEMENT SOLUTIONS, INC
Entity type:Organization
Organization Name:SYNERGY REHAB MANAGEMENT SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:RUEBEN
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-310-8500
Mailing Address - Street 1:1 LAKESHORE DR
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70629-0100
Mailing Address - Country:US
Mailing Address - Phone:337-310-8500
Mailing Address - Fax:337-310-8501
Practice Address - Street 1:1015 OBRIE ST
Practice Address - Street 2:
Practice Address - City:ZWOLLE
Practice Address - State:LA
Practice Address - Zip Code:71486-2510
Practice Address - Country:US
Practice Address - Phone:318-645-6458
Practice Address - Fax:318-645-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4376592960OtherBCBS OF LOUISIANA
LA1158876Medicaid
LA196631Medicare Oscar/Certification