Healthcare Provider Details

I. General information

NPI: 1528748613
Provider Name (Legal Business Name): THE WAVE INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 CAUSEWAY BLVD
TAMPA FL
33619-6608
US

IV. Provider business mailing address

28059 US HIGHWAY 19 N STE 205
CLEARWATER FL
33761-2620
US

V. Phone/Fax

Practice location:
  • Phone: 727-612-4907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ASHLEE T BRYANT
Title or Position: COO
Credential:
Phone: 727-612-4907