Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
TIDEWATER PHYSICAL THERAPY, INC.
Active
Organization
TIDEWATER PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHEDA BROUGHTON PESC (MANAGER, CREDENTIALING)
(252) 248-3313
Entity
Organization
Contact information
Practice address
135 HANBURY RD W, SUITE B, CHESAPEAKE, VA 23322-4291
(757) 819-6512
(757) 819-6517
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3313
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
VA
225X00000X
Occupational Therapist
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790014629
BCBS (PT & OT)
VA
01
—
223951126
DOL FECA
VA
Enumeration date
12/24/2009
Last updated
11/25/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up