Provider Demographics
NPI:1912340480
Name:SYNERGY MEDICAL STAFFING
Entity Type:Organization
Organization Name:SYNERGY MEDICAL STAFFING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GAUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:231-884-5450
Mailing Address - Street 1:8528 SILVER STRAND RD
Mailing Address - Street 2:
Mailing Address - City:LEVERING
Mailing Address - State:MI
Mailing Address - Zip Code:49755-9101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2829 BLUE SPRINGS PL
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8746
Practice Address - Country:US
Practice Address - Phone:813-991-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26136314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
26136OtherPT