Tidewater Physical Therapy LLC

NPI #1295256170 in Midlothian, Virginia

Provider Information

NPI Number: 1295256170
Entity Type: Organization
Organization Name: Tidewater Physical Therapy LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jun 30, 2017
Last Updated: Nov 25, 2024

Practice Location

Address: 15757 WC MAIN ST
City: Midlothian
State: Virginia
ZIP Code: 23113-7327
Phone: (804) 858-0220

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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