Provider Demographics
NPI:1386411700
Name:BRAINWAVE NEURO REHAB SERVICES LLC
Entity type:Organization
Organization Name:BRAINWAVE NEURO REHAB SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KROLL-ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:210-643-3534
Mailing Address - Street 1:12500 E ILIFF AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1268
Mailing Address - Country:US
Mailing Address - Phone:303-731-4620
Mailing Address - Fax:
Practice Address - Street 1:12500 E ILIFF AVE STE 300
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1268
Practice Address - Country:US
Practice Address - Phone:303-731-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy