Provider Demographics
NPI:1720863947
Name:TIDAL PERFORMANCE
Entity Type:Organization
Organization Name:TIDAL PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS, CMTPT
Authorized Official - Phone:508-631-1182
Mailing Address - Street 1:16 CADORET DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-3402
Mailing Address - Country:US
Mailing Address - Phone:508-631-1182
Mailing Address - Fax:
Practice Address - Street 1:90 HAYWARD ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-2153
Practice Address - Country:US
Practice Address - Phone:508-213-8258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy