Healthcare Provider Details

I. General information

NPI: 1477748119
Provider Name (Legal Business Name): WAVE HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 INTERPARK BLVD STE 300
SAN ANTONIO TX
78216-1852
US

IV. Provider business mailing address

121 INTERPARK BLVD STE 300
SAN ANTONIO TX
78216-1852
US

V. Phone/Fax

Practice location:
  • Phone: 210-593-9283
  • Fax: 210-593-9284
Mailing address:
  • Phone: 210-593-9283
  • Fax: 210-593-9284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY GRAY
Title or Position: OWNER
Credential:
Phone: 210-593-9283