Organization
TIDAL PHYSICAL THERAPY & PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS FREIJOMIL DPT (OWNER)
(856) 905-0057
Entity
Organization
Contact information
Practice address
154 COOPER RD STE 1601, WEST BERLIN, NJ 08091-9146
(856) 905-0057
Mailing address
154 COOPER RD STE 1601, WEST BERLIN, NJ 08091-9146
(856) 905-0057
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA01932000
LICENSE #
NJ
Enumeration date
10/14/2021
Last updated
10/14/2021
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