Individual provider Active NPI

Lilla B Whiteside, P.T.

  • Physical Therapist
  • Fredericksburg, VA
National Provider Identifier
1770524498
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT16287 Issued in FL
Practice address
10518 Spotsylvania Ave Ste 100
Fredericksburg, VA 22408-2693
Phone
(540) 710-5341
NPI assigned
Jun 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT16287 FL Primary

Addresses

Primary practice location

10518 Spotsylvania Ave Ste 100
Fredericksburg, VA 22408-2693

Mailing address

3428 N Roosevelt Blvd
Key West, FL 33040-4224
Phone (305) 295-9797

Other practice location 1

3428 N Roosevelt Blvd
Key West, FL 33040-4224
Phone (305) 295-9797

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240717003839 VA Practitioner - Physical Therapist in Private Practice 8123563897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Emory University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidewater Physical Therapy LLCGroup PAC ID 6406759281, 225 clinicians

Practice addresses (Care Compare)

10518 Spotsylvania Ave
Suite 100
Fredericksburg, VA 22408-2693
Phone (540) 710-5341

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT16287FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince May 23, 2025 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince May 23, 2025 Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

10518 Spotsylvania Ave
#100
Fredericksburg, VA 22408
Phone (540) 710-5341

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747785600000",
    "number": "1770524498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3428 N ROOSEVELT BLVD",
            "city": "KEY WEST",
            "state": "FL",
            "postal_code": "330404224",
            "telephone_number": "305-295-9797",
            "fax_number": "305-295-9796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10518 SPOTSYLVANIA AVE STE 100",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224082693",
            "telephone_number": "540-710-5341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3428 N Roosevelt Blvd",
            "address_purpose": "LOCATION",
            "city": "Key West",
            "state": "FL",
            "postal_code": "330404224",
            "country_code": "US",
            "telephone_number": "305-295-9797",
            "fax_number": "305-295-9796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITESIDE",
        "first_name": "LILLA",
        "middle_name": "B",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT16287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.