Provider Demographics
NPI:1396484283
Name:NEW WAVE INNOVATIONS, PLLC
Entity type:Organization
Organization Name:NEW WAVE INNOVATIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:COMRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-768-0516
Mailing Address - Street 1:3465 NATIONAL DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025
Mailing Address - Country:US
Mailing Address - Phone:469-768-0516
Mailing Address - Fax:
Practice Address - Street 1:3465 NATIONAL DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025
Practice Address - Country:US
Practice Address - Phone:469-768-0516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty