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Organization
WAVE PHYSICAL THERAPY LLC
Active
Organization
WAVE PHYSICAL THERAPY LLC
Active
Other names
Wave Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN DAVID BLACKWELL MSPT (OWNER)
(843) 437-8184
Entity
Organization
Contact information
Practice address
211 OAKWOOD DR, SUMMERVILLE, SC 29483-9701
(843) 437-8184
Mailing address
211 OAKWOOD DR, SUMMERVILLE, SC 29483-9701
(843) 437-8184
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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