Provider Demographics
NPI:1508619792
Name:MAKE WAVES THERAPY LLC
Entity Type:Organization
Organization Name:MAKE WAVES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-699-9316
Mailing Address - Street 1:1805 STAPLES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3633
Mailing Address - Country:US
Mailing Address - Phone:786-929-6162
Mailing Address - Fax:786-652-9781
Practice Address - Street 1:1805 STAPLES AVE STE 101
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3633
Practice Address - Country:US
Practice Address - Phone:786-929-6162
Practice Address - Fax:786-652-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health