Healthcare Provider Details

I. General information

NPI: 1255840757
Provider Name (Legal Business Name): WAV MOBILITY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 W SPUR AVE
GILBERT AZ
85233-6235
US

IV. Provider business mailing address

875 W SPUR AVE
GILBERT AZ
85233-6235
US

V. Phone/Fax

Practice location:
  • Phone: 602-206-5334
  • Fax: 888-346-2025
Mailing address:
  • Phone: 602-206-5334
  • Fax: 888-346-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DANIEL RADACOSKY
Title or Position: PRESIDENT
Credential:
Phone: 602-206-5334