Provider Demographics
NPI:1497243661
Name:WAVE THERAPY
Entity Type:Organization
Organization Name:WAVE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-512-6949
Mailing Address - Street 1:1515 LIGHTHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5900
Mailing Address - Country:US
Mailing Address - Phone:407-765-9664
Mailing Address - Fax:
Practice Address - Street 1:1515 LIGHTHOUSE CT
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-5900
Practice Address - Country:US
Practice Address - Phone:407-765-9664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy