NPIMap

Organization Active NPI

Tidewater Therapy for Children, PC

  • Pediatric Physical Therapist
  • Chesapeake, VA
National Provider Identifier
1386667400
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
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
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251P0200X 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 2

IdentifierTypeStateIssuer
57242OtherVAOPTIMA PROVIDER #
194322OtherVAANTHEM PROVIDER #

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386667400",
    "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": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUPREE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ML",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMA PROVIDER #",
            "identifier": "57242",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER #",
            "identifier": "194322",
            "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 Aug 22, 2020; 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.