Provider Demographics
NPI:1639515299
Name:WAVES PHYSICAL THERAPY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:WAVES PHYSICAL THERAPY AND WELLNESS CENTER
Other - Org Name:WAVES PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-780-7940
Mailing Address - Street 1:6588 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5615
Mailing Address - Country:US
Mailing Address - Phone:520-780-7940
Mailing Address - Fax:
Practice Address - Street 1:6588 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5615
Practice Address - Country:US
Practice Address - Phone:520-780-7940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty