Healthcare Provider Details

I. General information

NPI: 1013416965
Provider Name (Legal Business Name): NEW WAVE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 TURNER RD STE 101
ROCKLEDGE FL
32955-5726
US

IV. Provider business mailing address

7125 TURNER RD STE 101
ROCKLEDGE FL
32955-5726
US

V. Phone/Fax

Practice location:
  • Phone: 321-961-3805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAITLIN DONNER
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 321-961-3805