Provider Demographics
NPI:1215172408
Name:SYNERGY PHYSICAL THERAPY GROUP TRI COUNTY LLC
Entity type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY GROUP TRI COUNTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAKARI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERTTULA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-285-1377
Mailing Address - Street 1:61 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4124
Mailing Address - Country:US
Mailing Address - Phone:616-940-0660
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-735-8272
Practice Address - Fax:248-735-7276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1407Medicare PIN