Tidewater Physical Therapy, LLC
Organization Active NPI Physical Therapist · Glen Allen, VA
NPI 1457389595 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1457389595
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- TIDEWATER PHYSICAL THERAPY, LLC
- Practice address
- 10128 W Broad St BLDG III
Glen Allen, VA 23060-6761 - Phone
- (804) 217-9210
- Fax
- (804) 217-9213
- NPI assigned
- Jun 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Tasheda Broughton, PESC
- Title
- Manager, Credentialing
- Phone
- (252) 248-3313
Other NPIs on the same Medicare enrollment 11
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 27
Practitioners 450
-
Briana L Aiken, PT DPT
-
Madison Bre Allen, PT, DPT
-
Amanda T Alling, DPT
-
Mickayla Armour, DPT
-
Dharanisri Atluri, DPT
-
Caroline Averette, DPT
-
Stephen K Bailey, PT, DPT, CMTPT, FMSC
-
Brittany Baker, PT, DPT, ATC
-
Chauncey Barham, PT, DPT
-
Amy D. Beatty, PT, MPT
-
Cecilia Margaret Benzinger Gleim, PT, DPT, OCS
-
Minnie Bi, PT, DPT
-
Dianna Bishop, PT, DSC, CERT MDT, C
-
Bryce Bossin, PT
-
Melissa M Bowers, PT, MPT
-
Bruce G Brewer, PT, MSPT, CMTPT
-
Jessica Brown, DPT
-
Reina M Brown, PT, DPT
-
Corey Andrew Bryan, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA, DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041019001029 | VA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6406759281 |
Receives reassigned benefits from 379 practitioners 11 other NPIs on this enrollment |
| O20260514002582 | DC | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 6406759281 |
Receives reassigned benefits from 23 practitioners Practice locations: Fairfax, VA; Springfield, VA; Herndon, VA; Falls Church, VA; Arlington, VA; Alexandria, VA |
National Provider Directory
- Tax ID family
- Tidewater Physical Therapy LLC
Locations (25 of 31)
2400 Lakeside Dr
Ste 602F
Baltimore, MD 21264
350 New Fidelity Ct
Ste 311
Garner, NC 27529
20 State Route 10 W
Succasunna, NJ 07876
Phone (201) 549-5191
10640 Charter Hill Ct
Ste 102
Ashland, VA 23005
Phone (804) 550-5730
6325 Multiplex Dr
Unit 2
Centreville, VA 20121
Phone (571) 932-3470
10438 Iron Bridge Rd
Chester, VA 23831
Phone (804) 248-8277
10400 Iron Bridge Rd
Chester, VA 23831
Phone (804) 796-1518
300B Temple Lake Dr
Ste 1
Colonial Heights, VA 23834
Phone (804) 452-4903
1580 Armory Dr
Ste 100
Franklin, VA 23851
10128 W Broad St
Ste 3K
Glen Allen, VA 23060
10128 W Broad St
Ste K
Glen Allen, VA 23060
Phone (804) 217-9210
6965 Fox Hunt Ln
Ste 201
Gloucester, VA 23061
Phone (804) 694-8111
7190 Chapman Dr
Hayes, VA 23072
Phone (800) 464-2302
3051 George Washington Memorial Hwy
#8
Hayes, VA 23072
7493 Right Flank Rd
Mechanicsville, VA 23116
6049 Harbour Park Dr
Midlothian, VA 23112
Phone (804) 639-2359
12725 McManus Blvd
Ste 2E
Newport News, VA 23602
Phone (757) 874-0032
612 Denbigh Blvd
Newport News, VA 23608
Phone (757) 874-0032
751 Thimble Shoals Blvd
Newport News, VA 23606
823 Poplar Hall Dr
Norfolk, VA 23502
250 W Brambleton Ave
Ste 100
Norfolk, VA 23510
Phone (757) 938-6608
154 E Little Creek Rd
Norfolk, VA 23505
Phone (757) 797-0210
839 Poplar Hall Dr
Norfolk, VA 23502
Phone (757) 459-2112
227 Wadsworth Dr
North Chesterfield, VA 23236
Phone (804) 323-1874
3510 Anderson Hwy
#2
Powhatan, VA 23139
Phone (804) 598-2100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X | |||
| Clinic/Center | 261Q00000X |
Addresses
Primary practice location
10128 W Broad St BLDG III
Glen Allen, VA 23060-6761
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (252) 248-3313
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C12068 | Other | VA | MEDICARE RAILROAD |
Other names
- Pivot Physical Therapy of Virginia
Other providers in Glen Allen, VA
- James Edward Thompson
- Laura Thornton
- Andrew Thorpe
- Suzanne Coburn Throckmorton
- Tidewater Physical Therapy LLC
- Tidewater Physical Therapy, LLC
- Sandra Rexrode Timok
- Michael Maurice Tiomno
- TLN Professional Services PLLC
- TMS Neurohealth Centers Richmond LLC
All providers in Glen Allen, VA · Physical Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.