Provider Demographics
NPI:1699259432
Name:SYNERGY PHYSICAL THERAPY & PERFORMANCE
Entity type:Organization
Organization Name:SYNERGY PHYSICAL THERAPY & PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYSART
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:504-782-2439
Mailing Address - Street 1:1827 HICKORY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-5613
Mailing Address - Country:US
Mailing Address - Phone:504-782-2439
Mailing Address - Fax:
Practice Address - Street 1:1827 HICKORY AVE STE B
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-5613
Practice Address - Country:US
Practice Address - Phone:504-782-2439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty