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General NPI Number Information
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NPI Number | 1902573942
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Entity Type | Organization
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Legal Business Name | RISING TIDE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 308 53RD AVE E STE B
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City | BRADENTON
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State | FL
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Zip | 34203-4706
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Country | US
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Telephone | 941-739-0019
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Fax |
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Provider Business Mailing Address
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Address Line | 109 LAUREL RD E
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City | NOKOMIS
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State | FL
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Zip | 34275-5233
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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 | MGMR
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Name | KEN TRIBIT
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Credential | MS, PT
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Telephone | 941-706-1230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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