Synergy PT & Athletic Performance,LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305202615 Issued in VA

Legal business name

SYNERGY PT & ATHLETIC PERFORMANCE,LLC

Practice address

4720 Puddledock Rd Ste 130
Prince George, VA 23875-1275

Phone

(804) 520-7779

Fax

(866) 463-3074

NPI assigned

Aug 18, 2007

Last updated

Aug 20, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christian Dale Wheeler, MPT, DPT, CSCSNPI 1982652830

Title

Owner

Phone

(804) 520-7779

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christian Dale Wheeler, MPT, CSCS

  • Physical Therapist
  • Colonial Heights, VA
  • NPI 1982652830
  Medicare reassignment NPD Authorized official
• Jordyn Leonard, PT, DPT

  • Physical Therapist
  • Prince George, VA
  • NPI 1669100129
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629417600000",
    "number": "1962695411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 PUDDLEDOCK RD",
            "address_2": "SUITE 130",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751275",
            "telephone_number": "804-520-7779",
            "fax_number": "866-463-3047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4720 PUDDLEDOCK RD STE 130",
            "city": "PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238751275",
            "telephone_number": "804-520-7779",
            "fax_number": "866-463-3074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYNERGY PT & ATHLETIC PERFORMANCE,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-18",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "CHRISTIAN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-520-7779",
        "authorized_official_credential": "MPT, DPT, CSCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305202615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Baljit S Sidhu, MD
• Dustin Smallwood, RRT
• SMJ Medical Enterprises, LLC
• Melanie Wexel Spears, D.D.S., M.S.
• Stewardship of Hope Counseling Services LLC
• Tierra Tart
• Khin Kyaw Kyaw Thein, M.D., M.S.
• Ronnie Thompson
• Braheem Tolbert, DC
• Maria Elisabeth Towle

• Physical Therapist in Prince George, VA
• Providers in Prince George, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.