Provider Demographics
NPI:1932291002
Name:WAVE PHYSICAL THERAPY, INCORPORATED
Entity Type:Organization
Organization Name:WAVE PHYSICAL THERAPY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:423-227-0386
Mailing Address - Street 1:4204 BENTON DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37406-1256
Mailing Address - Country:US
Mailing Address - Phone:423-227-0386
Mailing Address - Fax:
Practice Address - Street 1:4204 BENTON DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-1256
Practice Address - Country:US
Practice Address - Phone:423-227-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty