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Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Organization
TIDEWATER PHYSICAL THERAPY LLC
Active
Other names
Pivot Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
44 BROAD STREET RD, MANAKIN SABOT, VA 23103-2213
(804) 784-7090
(804) 784-7092
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
01/23/2018
Last updated
11/25/2024
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