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General NPI Number Information
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NPI Number | 1851010698
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Entity Type | Organization
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Legal Business Name | TIDAL THERAPY SOLUTIONS LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2761 NC HIGHWAY 210 E STE G102
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City | HAMPSTEAD
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State | NC
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Zip | 28443-8955
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Country | US
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Telephone | 910-541-3636
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Fax | 910-928-2496
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Provider Business Mailing Address
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Address Line | 376 FRISCO WAY
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City | HOLLY RIDGE
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State | NC
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Zip | 28445-4202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELE MARIE MCLEAN
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Credential |
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Telephone | 201-403-5826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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