Tidewater Physical Therapy, LLC

NPI #1740215250 in Hampton, Virginia

Provider Information

NPI Number: 1740215250
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: 2106 EXECUTIVE DR
City: Hampton
State: Virginia
ZIP Code: 23666-2402
Phone: (757) 838-6678

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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