Provider Demographics
NPI:1063142818
Name:SYNCHRONICITY MBS
Entity type:Organization
Organization Name:SYNCHRONICITY MBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:208-918-6136
Mailing Address - Street 1:6848 N GOVERNMENT WAY STE 111
Mailing Address - Street 2:
Mailing Address - City:DALTON GARDENS
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7778
Mailing Address - Country:US
Mailing Address - Phone:208-252-6362
Mailing Address - Fax:
Practice Address - Street 1:6848 N GOVERNMENT WAY STE 111
Practice Address - Street 2:
Practice Address - City:DALTON GARDENS
Practice Address - State:ID
Practice Address - Zip Code:83815-7778
Practice Address - Country:US
Practice Address - Phone:208-252-6362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy