Healthcare Provider Details

I. General information

NPI: 1124679907
Provider Name (Legal Business Name): PRECISION WAVE RECOVERY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 MAIN ST STE 365
HOUSTON TX
77030-4456
US

IV. Provider business mailing address

7220 W JEFFERSON AVE
LAKEWOOD CO
80235-2031
US

V. Phone/Fax

Practice location:
  • Phone: 832-384-4106
  • Fax: 713-943-2225
Mailing address:
  • Phone: 303-922-4636
  • Fax: 303-922-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CALVIN PARKS JR.
Title or Position: GENERAL PARTNER
Credential: CEO
Phone: 229-291-7287