Provider Demographics
NPI:1720970106
Name:TINY TIDES PEDIATRIC THERAPY
Entity type:Organization
Organization Name:TINY TIDES PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:REED
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CETTI
Authorized Official - Suffix:
Authorized Official - Credentials:OT R/L
Authorized Official - Phone:912-659-1246
Mailing Address - Street 1:8 BAKERS XING
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5160
Mailing Address - Country:US
Mailing Address - Phone:912-659-1246
Mailing Address - Fax:
Practice Address - Street 1:8 BAKERS XING
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5160
Practice Address - Country:US
Practice Address - Phone:912-659-1246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1902577810Medicaid