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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
203 N WASHINGTON HWY, ASHLAND, VA 23005-1623
(804) 798-1112
(804) 798-1171
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3313
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
01/20/2022
Last updated
12/06/2024
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