# TIDAL CREEK PHYSICAL THERAPY, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598358954
- **Authorized official:** JEREMY CANNON (OWNER)
- **Authorized official phone:** (843) 379-3991

## Contact information

- **Practice address:** 95 SEA ISLAND PKWY STE 103, BEAUFORT, SC 29907-1499
- **Practice address phone:** (803) 942-6412
- **Mailing address:** 95 SEA ISLAND PKWY STE 103, BEAUFORT, SC 29907-1499
- **Mailing address phone:** (843) 379-3991

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 07/09/2024