Tidewater Physical Therapy, LLC

NPI #1003114083 in Richmond, Virginia

Provider Information

NPI Number: 1003114083
Entity Type: Organization
Organization Name: Tidewater Physical Therapy, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Mar 1, 2011
Last Updated: Nov 25, 2024

Practice Location

Address: 4831 S LABURNUM AVE
City: Richmond
State: Virginia
ZIP Code: 23231-2713
Phone: (804) 222-0746

Authorized Official

Name: TASHEDA BROUGHTON, PESC
Title: MANGER, CREDENTIALING
Phone: (252) 248-3313

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Physical Therapist	225100000X	Primary

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