Organization
BLUE TIDE PEDIATRIC THERAPY LLC
Active
Other names
Blue Tide Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
GARRETT OUTLAND MA, CCC-SLP (OWNER/SPEECH-LANGUAGE PATHOLOGIST)
(850) 964-6162
Entity
Organization
Contact information
Practice address
4641 GULFSTARR DR STE 102, DESTIN, FL 32541-3776
(850) 964-6162
(850) 848-6643
Mailing address
4641 GULFSTARR DR STE 102, DESTIN, FL 32541-3776
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
—
225700000X
Massage Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/05/2022
Last updated
01/13/2025
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