NEURO WAVE PHYSIOLOGY, LLC (NPI# 1487047551) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487047551 |
| Entity Type | Organization |
| Organization Name | NEURO WAVE PHYSIOLOGY, LLC |
| Practice Address |
1420 Marvin Rd Ne Ste C #316 Lacy WA 98516-3878 |
| Practice Telephone | 3608191474 |
| Mailing Telephone | (360) 819-1474 |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2017-08-24 |
| Authorized Official Name | LIZETTE MORIN (MDMS NPI COMPLIANCE OFFICER) |
| Authorized Official Telephone | 2105982801 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 246ZE0600X |
Specialist/Technologist, Other Specialization: Electroneurodiagnostic |
Technologists, Technicians & Other Technical Service Providers | ||
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
Allopathic & Osteopathic Physicians |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | NEURO WAVE PHYSIOLOGY, LLC | 1141 N Loop 1604 E Ste 105-612, San Antonio, TX 78232 |
| Street Address |
1420 MARVIN RD NE STE C #316 |
| City | LACY |
| State | WA |
| Zip Code | 98516-3878 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730744210 | Michael Oropeza | Behavioral Analyst | 8282 28th Court Northeast, Suite A, Lacey, WA 98516 | 2019-05-09 |
| 1902361330 | Amanda Jessica Mae Allen | Behavioral Analyst | Basics Nw LLC, 8282 28th Ct Ne Suite A, Lacey, WA 98516 | 2019-02-11 |
| 1619459393 | Kayla-renee Williams | Behavioral Analyst | Basics Nw LLC 8282 28th Ct Ne, Suite A, Lacey, WA 98516 | 2018-08-30 |
| 1174004303 | Julie Ann Lisowski | Massage Therapist | 3532 Cuddy Ln Ne, Lacey, WA 98516 | 2018-08-26 |
| 1740700145 | Joseph Brandon Kimmel | Denturist | 5032 Beverly Dr Ne, Olympia, WA 98516 | 2017-06-27 |
| 1649649880 | Katie Cole | Behavioral Analyst | 8282 28th Ct Ne, Suite A, Basics Nw, LLC, Lacey, WA 98516 | 2015-09-17 |
| 1306234166 | Reza Tahernia | Dentist | 8050 Freedon Lane Ne, Suite C, Lacey, WA 98516 | 2015-01-02 |
| 1770997603 | Qualified Surgical Services Pllc | Surgery | 3697 Cameron Dr Ne, Lacey, WA 98516 | 2014-06-18 |
| 1184048688 | Stephanie Renee Hjortedal | Specialist/Technologist | 8750 Tallon Lane Ne., Lacey, WA 98516 | 2014-02-05 |
| 1295169811 | Teasha Corrado | Behavioral Analyst | 8282 28th Court Ne, Suite A, Lacey, WA 98516 | 2013-08-30 |
| Find all providers in zip 98516 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942643440 | Somayyeh Sadat Sabet | Psychiatry & Neurology | 1536 N 115th St Ste 330, Seattle, WA 98133-8425 | 2013-04-15 |
| 1972876829 | Donald Francis Farrell | Psychiatry & Neurology | 5207 115th St Se, Everett, WA 98208-9199 | 2012-02-22 |
| 1477520682 | William D Cagle | Psychiatry & Neurology | 92 Fishermen Pl, Manson, WA 98831 | 2006-03-07 |
| 1902878580 | John Peter Ney | Psychiatry & Neurology | 9040a Fitzsimmons Dr., Tacoma, WA 98413 | 2006-02-07 |
| 1104104322 | Elisabeth Simard-tremblay | Psychiatry & Neurology | 1959 Ne Pacific St, Box 356465, Seattle, WA 98195-6465 | 2011-07-22 |
| 1588988521 | C William Britt Jr Md Pllc | Psychiatry & Neurology | 42 E Rowan Ave, Suite B, Spokane, WA 99207-1212 | 2010-03-19 |
| 1073650669 | Robert Emery Potts | Psychiatry & Neurology | Madigan Army Medical Ctr, 9040a Fitzsimmons Drive, Tacoma, WA 98431-1100 | 2007-01-31 |
| 1225128119 | John D Kuratani | Psychiatry & Neurology | 4800 Sand Point Way Ne, Seattle, WA 98105-3901 | 2006-10-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.