Tidewater Physical Therapy, LLC

NPI #1790270973 in Stafford, Virginia

Provider Information

NPI Number: 1790270973
Entity Type: Organization
Organization Name: Tidewater Physical Therapy, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Jun 29, 2018
Last Updated: Nov 25, 2024

Practice Location

Address: 392 GARRISONVILLE RD STE 208
City: Stafford
State: Virginia
ZIP Code: 22554-1576
Phone: (540) 602-4277

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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