Provider Demographics
NPI:1982901708
Name:SYNERGY PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:413-727-3315
Mailing Address - Street 1:39 CARLON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2374
Mailing Address - Country:US
Mailing Address - Phone:413-727-3315
Mailing Address - Fax:413-727-3316
Practice Address - Street 1:39 CARLON DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2374
Practice Address - Country:US
Practice Address - Phone:413-727-3315
Practice Address - Fax:413-727-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18949225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609182856OtherPROVIDER NPI