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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
100 WINTERS ST, SUITE 106, WEST POINT, VA 23181-9534
(804) 843-9033
(804) 843-9037
Mailing address
2122 YORK RD STE 300, OAK BROOK, IL 60523-1925
(252) 248-3133
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
VA
225X00000X
Occupational Therapist
—
VA
Other
Enumeration date
03/18/2013
Last updated
12/06/2024
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