Tidewater Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

TIDEWATER PHYSICAL THERAPY, LLC

Practice address

612 Denbigh Blvd
Newport News, VA 23608-4416

Phone

(757) 874-0032

Fax

(757) 874-0127

NPI assigned

Jul 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tasheda Broughton, PESC

Title

Manager, Credentialing

Phone

(252) 248-3313

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1295760700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "252-248-3313",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 DENBIGH BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236084416",
            "telephone_number": "757-874-0032",
            "fax_number": "757-874-0127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "BROUGHTON",
        "authorized_official_first_name": "TASHEDA",
        "authorized_official_title_or_position": "MANAGER, CREDENTIALING",
        "authorized_official_telephone_number": "252-248-3313",
        "authorized_official_credential": "PESC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS (PT)",
            "identifier": "192948",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS (OT)",
            "identifier": "192950",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tidewater Counseling Group, LLC
• Tidewater Family Dentistry
• Tidewater Foot Center LLC
• Tidewater Hearing Center
• Tidewater Institute of NLP
• Tidewater Physical Therapy, LLC
• Tidewater Physical Therapy, LLC
• Tidewater Physicians Multispecialty Group
• Tidewater Physicians Multispecialty Group PC
• Tidewater Physicians Multispecialty Group PC

• Physical Therapist in Newport News, VA
• Providers in Newport News, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.