Organization · Type 2 NPI

Blue Tide Pediatric Therapy LLC

Clinic/Center · Destin, FL

NPI number 1114654431 Active

Practice location

4641 Gulfstarr Dr Ste 102
Destin, FL 32541-3776

Fax (850) 848-6643

Specialties and licenses

Taxonomy	Code	License
Psychiatry Physician	2084P0800X	None listed
Massage Therapist	225700000X	None listed
Speech-Language Pathologist	235Z00000X	None listed
Clinic/Center Primary	261Q00000X	None listed

Clinic/Center: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

Other clinic/center providers in Destin

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NPI record

NPI: 1114654431
Entity type: Organization (Type 2)
Issued: Aug 5, 2022
Last updated: Jan 13, 2025
Status: Active

Other names

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Blue Tide Therapy · doing business as
Blue Tide Therapy · doing business as

Authorized official

Garrett Outland, MA, CCC-SLP
Owner/speech-Language Pathologist
(850) 964-6162

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1114654431

Blue Tide Pediatric Therapy LLC's National Provider Identifier is 1114654431, issued on Aug 5, 2022. The primary taxonomy on file is Clinic/Center (261Q00000X), and the practice location is in Destin, FL. The record was last updated on Jan 13, 2025.