Tidewater Physical Therapy, LLC
NPI #1932648649 in Charlottesville, Virginia
Provider Information
- NPI Number
- 1932648649
- Entity Type
- Organization
- Organization Name
- Tidewater Physical Therapy, LLC
- Primary Specialty
- Physical Therapist
- Enumeration Date
- Feb 14, 2017
- Last Updated
- Sep 2, 2025
Practice Location
- Address
- 1490 PANTOPS MOUNTAIN PL
- Address 2
- SUITE 202
- City
- Charlottesville
- State
- Virginia
- ZIP Code
- 22911-4601
- Phone
- (434) 245-6472
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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