Provider Demographics
NPI:1306698535
Name:MAKING WAVES PEDIATRIC THERAPY SERVICE
Entity type:Organization
Organization Name:MAKING WAVES PEDIATRIC THERAPY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINKLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:859-492-7257
Mailing Address - Street 1:4103 BOLLING BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299
Mailing Address - Country:US
Mailing Address - Phone:859-492-7257
Mailing Address - Fax:
Practice Address - Street 1:4103 BOLLING BROOK DRIVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:859-492-7257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty