Tidewater Physical Therapy, LLC

NPI #1881133791 in Palmyra, Virginia

Provider Information

NPI Number: 1881133791
Entity Type: Organization
Organization Name: Tidewater Physical Therapy, LLC
Primary Specialty: Physical Therapist
Enumeration Date: Feb 13, 2017
Last Updated: Sep 2, 2025

Practice Location

Address: 77 MARKET ST
Address 2: SUITE B
City: Palmyra
State: Virginia
ZIP Code: 22963-4687
Phone: (434) 510-7301

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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