Provider Demographics
NPI:1720825292
Name:SYNERGY THERAPEUTICS LLC
Entity type:Organization
Organization Name:SYNERGY THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LMT
Authorized Official - Prefix:
Authorized Official - First Name:KESTREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:541-515-0232
Mailing Address - Street 1:1245 CHARNELTON ST STE 7
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6206
Mailing Address - Country:US
Mailing Address - Phone:541-515-0232
Mailing Address - Fax:
Practice Address - Street 1:1245 CHARNELTON ST STE 7
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6206
Practice Address - Country:US
Practice Address - Phone:541-515-0232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty