Blue Tide Pediatric Therapy LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BLUE TIDE PEDIATRIC THERAPY LLC

Doing business as

Blue Tide Therapy

Practice address

4641 Gulfstarr Dr Ste 102
Destin, FL 32541-3776

Phone

(850) 964-6162

Fax

(850) 848-6643

NPI assigned

Aug 5, 2022

Last updated

Jan 13, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Garrett Outland, MA, CCC-SLPNPI 1104491125

Title

Owner/Speech-Language Pathologist

Phone

(850) 964-6162

Specialties & licenses 4

Addresses

Other names 1

• Blue Tide Therapy Doing business as

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Garrett Outland, MA, CCC-SLP

  • Speech-Language Pathologist
  • Orlando, FL
  • NPI 1104491125
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1114654431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 GULFSTARR DR STE 102",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325413776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 GULFSTARR DR STE 102",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "325413776",
            "telephone_number": "850-964-6162",
            "fax_number": "850-848-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE TIDE PEDIATRIC THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-05",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "OUTLAND",
        "authorized_official_first_name": "GARRETT",
        "authorized_official_title_or_position": "OWNER/SPEECH-LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "850-964-6162",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://secure.simplepractice.com/",
            "affiliation": "N",
            "endpointDescription": "SimplePractice",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4641 Gulfstarr Dr Ste 102",
            "city": "Destin",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325413776",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Blue Tide Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Tide Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dia Bobb, FNP
• Tracy Bobbitt, OTA

• Clinic/Center in Destin, FL
• Providers in Destin, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.