Provider Demographics
NPI:1609762970
Name:LITTLE TIDES THERAPY LLC
Entity type:Organization
Organization Name:LITTLE TIDES THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-252-9844
Mailing Address - Street 1:11160 VIDA CIRCLE
Mailing Address - Street 2:UNIT 105
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211
Mailing Address - Country:US
Mailing Address - Phone:786-252-9844
Mailing Address - Fax:
Practice Address - Street 1:11160 VIDA CIRCLE
Practice Address - Street 2:UNIT 105
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211
Practice Address - Country:US
Practice Address - Phone:786-252-9844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health