Healthcare Provider Details

I. General information

NPI: 1417888959
Provider Name (Legal Business Name): TIDALHEALTH SPECIALTY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GLEN AVE STE 203
SALISBURY MD
21804-5263
US

IV. Provider business mailing address

1675 WOODBROOKE DR
SALISBURY MD
21804-8502
US

V. Phone/Fax

Practice location:
  • Phone: 410-341-9535
  • Fax: 410-341-9536
Mailing address:
  • Phone: 410-749-4154
  • Fax: 410-860-9583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA ONEILL ALLMAN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 410-860-4506