Healthcare Provider Details

I. General information

NPI: 1699607788
Provider Name (Legal Business Name): WAVE TREATMENT CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

IV. Provider business mailing address

777 37TH ST STE C103
VERO BEACH FL
32960-7301
US

V. Phone/Fax

Practice location:
  • Phone: 772-300-9077
  • Fax: 215-764-6447
Mailing address:
  • Phone: 772-300-9077
  • Fax: 215-764-6447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN A BEATTY
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 772-300-9077