# WAVE PHYSICAL THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wave Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346859881
- **Authorized official:** JONATHAN DAVID BLACKWELL MSPT (OWNER)
- **Authorized official phone:** (843) 437-8184

## Contact information

- **Practice address:** 211 OAKWOOD DR, SUMMERVILLE, SC 29483-9701
- **Practice address phone:** (843) 437-8184
- **Mailing address:** 211 OAKWOOD DR, SUMMERVILLE, SC 29483-9701
- **Mailing address phone:** (843) 437-8184

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2020
- **Last updated:** 07/30/2020