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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
4020 RAINTREE RD, STE D, CHESAPEAKE, VA 23321-3749
(757) 484-4241
(757) 484-4487
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192941
BCBS (PT)
VA
Enumeration date
07/12/2006
Last updated
11/25/2024
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