Organization
TIDAL CREEK PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY CANNON (OWNER)
(843) 379-3991
Entity
Organization
Contact information
Practice address
95 SEA ISLAND PKWY STE 103, BEAUFORT, SC 29907-1499
(803) 942-6412
Mailing address
95 SEA ISLAND PKWY STE 103, BEAUFORT, SC 29907-1499
(843) 379-3991
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
02/17/2021
Last updated
07/09/2024
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