# TIDAL CREEK PHYSICAL THERAPY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TIDAL CREEK PHYSICAL, LLC
- **Other names:** Tidal Creek Physical Beaufort
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1851129977
- **Legal business name:** TIDAL CREEK PHYSICAL, LLC
- **Authorized official:** JEREMY CANNON PTA (PTA)
- **Authorized official phone:** (843) 379-3991

## Contact information

- **Practice address:** 95 SEA ISLAND PKWY STE 103, BEAUFORT, SC 29907-1499
- **Practice address phone:** (843) 379-3991
- **Mailing address:** 11 ROBERT SMALLS PKWY, BEAUFORT, SC 29906-4202
- **Mailing address phone:** (843) 379-3991
- **Mailing address fax:** (843) 582-0283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/22/2024
- **Last updated:** 01/06/2025