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Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Other names
Pivot Physical Therapy of Virginia
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
2400 LAKESIDE DRIVE, SUITE 602F, LYNCHBURG, VA 24501
(434) 338-7215
(434) 212-1936
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
VA
Other
Enumeration date
12/06/2017
Last updated
11/25/2024
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