Provider Demographics
NPI:1306634084
Name:PHYSIOWAVE ELECTRODIAGNOSTICS PLLC
Entity type:Organization
Organization Name:PHYSIOWAVE ELECTRODIAGNOSTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:267-337-4139
Mailing Address - Street 1:420 CHARIOT CT
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3773
Mailing Address - Country:US
Mailing Address - Phone:267-337-4139
Mailing Address - Fax:267-337-4139
Practice Address - Street 1:420 CHARIOT CT
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3773
Practice Address - Country:US
Practice Address - Phone:267-337-4139
Practice Address - Fax:267-337-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory