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General NPI Number Information
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NPI Number | 1215726344
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Entity Type | Organization
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Legal Business Name | TIDAL PHYSICAL THERAPY AND WELLNESS, PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 88 BRIDGE ST
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City | DEDHAM
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State | MA
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Zip | 02026-1702
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Country | US
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Telephone | 401-216-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 9 NANCY RD
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City | MILTON
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State | MA
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Zip | 02186-4623
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Country | US
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Telephone | 203-273-3294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIANNE BECK
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Credential | PT, DPT, OCS
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Telephone | 203-273-3294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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