Healthcare Provider Details

I. General information

NPI: 1851010698
Provider Name (Legal Business Name): TIDAL THERAPY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 NC HIGHWAY 210 E STE G102
HAMPSTEAD NC
28443-8955
US

IV. Provider business mailing address

376 FRISCO WAY
HOLLY RIDGE NC
28445-4202
US

V. Phone/Fax

Practice location:
  • Phone: 910-541-3636
  • Fax: 910-928-2496
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIELE MARIE MCLEAN
Title or Position: OWNER
Credential:
Phone: 201-403-5826