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General NPI Number Information
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NPI Number | 1851082812
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Entity Type | Organization
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Legal Business Name | SECOND WAVE PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 735 W CHANNEL ISLANDS BLVD
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City | PORT HUENEME
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State | CA
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Zip | 93041-2130
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Country | US
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Telephone | 805-250-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 735 W CHANNEL ISLANDS BLVD
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City | PORT HUENEME
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State | CA
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Zip | 93041-2130
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Country | US
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Telephone | 805-250-7505
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | STEPHANIE CATTANO
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Credential | PT, DPT
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Telephone | 860-459-6735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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