NPIMap

Organization Active NPI

Tidewater Therapy for Children, PC

  • Early Intervention Provider Agency
  • Chesapeake, VA
National Provider Identifier
1316051287
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Early Intervention Provider AgencyTaxonomy code 252Y00000X
Legal business name
TIDEWATER THERAPY FOR CHILDREN, PC
Practice address
4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Phone
(757) 488-2864
Fax
(757) 488-4735
NPI assigned
Aug 18, 2006
Last updated
Apr 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2026

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

Authorized official

Name
Mrs. Jessica M Dupree, BS
Title
Office/Insurance Manager
Phone
(757) 488-2864

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X
Pediatric Occupational Therapist 225XP0200X
Speech-Language Pathologist 235Z00000X
Early Intervention Provider Agency 252Y00000X Primary

Addresses

Primary practice location

4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700

Mailing address

4016 Raintree Rd
Suite 240
Chesapeake, VA 23321-3700
Phone (757) 488-2864

Other identifiers 1

IdentifierTypeStateIssuer
004979061MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130408000465 VA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 3779511019 Practice locations: Chesapeake, VA

National Provider Directory

National Provider Directory
Tax ID family
Tidewater Therapy for Children PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4016 Raintree Rd
Ste 100
Chesapeake, VA 23321
Phone (757) 488-2864

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1316051287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4016 RAINTREE RD",
            "address_2": "SUITE 240",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213700",
            "telephone_number": "757-488-2864",
            "fax_number": "757-488-4735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4016 RAINTREE RD",
            "address_2": "SUITE 240",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233213700",
            "telephone_number": "757-488-2864",
            "fax_number": "757-488-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER THERAPY FOR CHILDREN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A",
        "authorized_official_last_name": "DUPREE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE/INSURANCE MANAGER",
        "authorized_official_telephone_number": "757-488-2864",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004979061",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.