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
—
—
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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