MEDICARE: HEALTHWAVE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT8057	FL

General Provider Information

NPI Number	:	1003032897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWAVE INC

Provider Business Mailing Address
First Line	:	1401 PENMAN RD STE C
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3647
Country	:	US
Telephone Number	:	904-242-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 PENMAN RD STE C
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3647
Country	:	US
Telephone Number	:	904-242-0707
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	JOYCE TUCKER
Credential	:
Telephone Number	:	904-272-3440

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/22/2020

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Directions to “HEALTHWAVE INC ” Practice Location

Language	Start Address	Practice Location

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