Healthcare Provider Details

I. General information

NPI: 1720863947
Provider Name (Legal Business Name): TIDAL PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HAYWARD ST
FRANKLIN MA
02038-2153
US

IV. Provider business mailing address

16 CADORET DR
CUMBERLAND RI
02864-3402
US

V. Phone/Fax

Practice location:
  • Phone: 508-213-8258
  • Fax:
Mailing address:
  • Phone: 508-631-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH LAUDONE
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT, OCS, CMTPT
Phone: 508-631-1182