Provider Demographics
NPI:1841665718
Name:SYNERGY HEALTHCARE PHYSICAL MEDICINE
Entity type:Organization
Organization Name:SYNERGY HEALTHCARE PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-688-4484
Mailing Address - Street 1:350 CIMMERON DR
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-7511
Mailing Address - Country:US
Mailing Address - Phone:309-688-4484
Mailing Address - Fax:309-688-4485
Practice Address - Street 1:350 CIMMERON DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-7511
Practice Address - Country:US
Practice Address - Phone:309-688-4484
Practice Address - Fax:309-688-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty