Tidewater Physical Therapy, LLC

NPI #1366477564 in Norfolk, Virginia

Provider Information

NPI Number: 1366477564
Entity Type: Organization
Organization Name: Tidewater Physical Therapy, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jul 12, 2006
Last Updated: Nov 25, 2024

Practice Location

Address: 6161 KEMPSVILLE CIR
Address 2: SUITE 250
City: Norfolk
State: Virginia
ZIP Code: 23502-3932
Phone: (757) 965-4890

Authorized Official

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

Specialties & Taxonomy Codes

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

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