Provider Demographics
NPI:1447203369
Name:SYNERGY ORTHOTICS & PROSTHETICS, LLC
Entity type:Organization
Organization Name:SYNERGY ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:214-239-2970
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5009
Mailing Address - Country:US
Mailing Address - Phone:214-239-2970
Mailing Address - Fax:214-239-2974
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5009
Practice Address - Country:US
Practice Address - Phone:214-239-2970
Practice Address - Fax:214-239-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101197332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101197OtherTEXAS O&P FACILITY LICENS
TX011068601Medicaid
TX101197OtherTEXAS O&P FACILITY LICENS