Tidewater Physical Therapy, LLC
NPI #1619992872 in Gloucester, Virginia
Provider Information
- NPI Number
- 1619992872
- 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
- 6970 FOX HUNT LN
- City
- Gloucester
- State
- Virginia
- ZIP Code
- 23061-5394
- Phone
- (804) 694-8111
Authorized Official
- Name
- TASHEDA BROUGHTON, PESC
- Title
- MANAGER, CREDENTIALING
- Phone
- (252) 248-3313
Specialties & Taxonomy Codes
| Specialty |
|---|
| Occupational Therapist |
| Physical Therapist |
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