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General NPI Number Information
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NPI Number | 1255930855
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Entity Type | Organization
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Legal Business Name | TIDELINE SPORTS PERFORMANCE & REHABILITATION LLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 5320 LENA RD UNIT 114
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City | BRADENTON
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State | FL
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Zip | 34211-9438
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Country | US
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Telephone | 513-460-8005
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Fax |
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Provider Business Mailing Address
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Address Line | 5320 LENA RD UNIT 114
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City | BRADENTON
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State | FL
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Zip | 34211-9438
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Country | US
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Telephone | 513-460-8005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SCLAFANI
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Credential | DPT
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Telephone | 941-218-0551
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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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