Healthcare Provider Details

I. General information

NPI: 1710292503
Provider Name (Legal Business Name): BIOWAVE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3867 MEDINA RD
AKRON OH
44333-4506
US

IV. Provider business mailing address

3867 MEDINA RD P.O. BOX 0194
AKRON OH
44333-4506
US

V. Phone/Fax

Practice location:
  • Phone: 859-221-1219
  • Fax:
Mailing address:
  • Phone: 859-221-1219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY D BLANC
Title or Position: MANAGING PARTNER
Credential:
Phone: 859-221-1219