Tidewater Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

TIDEWATER PHYSICAL THERAPY, LLC

Practice address

6049 Harbour Park Dr
Midlothian, VA 23112-2160

Phone

(804) 639-2359

Fax

(804) 639-2029

NPI assigned

Jul 4, 2006

Last updated

Nov 25, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Other NPIs on the same Medicare enrollment 11

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Tidewater Physical Therapy, Inc.

  • Physical Therapist
  • Chesapeake, VA
  • NPI 1790014629

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Richmond, VA
  • NPI 1003114083

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  dba Pivot Physical Therapy of Virginia

  • Physical Therapist
  • Chesapeake, VA
  • NPI 1215952361

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Norfolk, VA
  • NPI 1366477564

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  dba Pivot Physical Therapy of Virginia

  • Physical Therapist
  • Glen Allen, VA
  • NPI 1457389595

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Newport News, VA
  • NPI 1467471896

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Williamsburg, VA
  • NPI 1477588606

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Glen Allen, VA
  • NPI 1477588986

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Gloucester, VA
  • NPI 1619992872

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Newport News, VA
  • NPI 1669493474

  O20041019001029

  Same enrollment
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Hampton, VA
  • NPI 1740215250

  O20041019001029

  Same enrollment

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1508896622",
    "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": "919-258-2714",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6049 HARBOUR PARK DR",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231122160",
            "telephone_number": "804-639-2359",
            "fax_number": "804-639-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEWATER PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "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": [],
    "endpoints": [],
    "other_names": []
}

• Three Pillars Senior Home Care LLC
• Threshold Medical, PLC (Threshold Medical)
• Kendall V Thurman, D.O.
• Tidewater Physical Therapy LLC (Pivot Physical Therapy of Virginia)
• Tidewater Physical Therapy LLC (Pivot Physical Therapy)
• Samantha Tieng
• Tiesing Healthcare
• Sarah W Tiesing
• Dana M Timmer, M.A.
• Jelisa A Timmons, M.D.

• Physical Therapist in Midlothian, VA
• Providers in Midlothian, 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.
• 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.