Tidewater Physical Therapy, LLC
NPI #1457389595 in Glen Allen, Virginia
Provider Information
- NPI Number
- 1457389595
- Entity Type
- Organization
- Organization Name
- Tidewater Physical Therapy, LLC
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Jun 29, 2006
- Last Updated
- Nov 19, 2024
Practice Location
- Address
- 10128 W BROAD ST BLDG III
- City
- Glen Allen
- State
- Virginia
- ZIP Code
- 23060-6761
- Phone
- (804) 217-9210
Authorized Official
- Name
- TASHEDA BROUGHTON, PESC
- Title
- MANAGER, CREDENTIALING
- Phone
- (252) 248-3313
Specialties & Taxonomy Codes
| Specialty |
|---|
| Occupational Therapist |
| Speech-Language Pathologist |
| Clinic/Center |
| Physical Therapist |
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