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Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
1033 CHAMPIONS WAY STE 500, SUFFOLK, VA 23435-3775
(757) 372-9953
(757) 372-9954
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 578-4538
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/20/2022
Last updated
11/25/2024
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