Organization
SYNERGY ORTHOTICS & PROSTHETICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNY EMMANUEL BASKIN CP (OWNER/ PRACTITIONER)
(703) 209-3790
Entity
Organization
Contact information
Practice address
44790 MAYNARD SQ STE 240, ASHBURN, VA 20147-6514
(571) 442-8514
(571) 442-8519
Mailing address
44790 MAYNARD SQ STE 240, ASHBURN, VA 20147-6514
(571) 442-8514
(571) 442-8519
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CP03073
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069832900
—
DC
05
—
3358399-00
—
MD
Enumeration date
04/24/2013
Last updated
03/03/2021
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