Organization
TIDEWATER REHABILITATION MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN WALTER KAYOTA M.D. (SOLE OWNER/AUTHORIZE OFFICIAL)
(757) 496-2325
Entity
Organization
Contact information
Practice address
1120 FIRST COLONIAL RD, SUITE 206, VIRGINIA BEACH, VA 23454-2418
(757) 496-2325
(757) 496-1942
Mailing address
1120 FIRST COLONIAL RD, SUITE 206, VIRGINIA BEACH, VA 23454-2418
(757) 496-2325
(757) 496-1942
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0101053621
VA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
0101053621
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891113155
AETNA
VA
05
—
1891113155
—
VA
01
—
618120600
DEPARTMENT OF LABOR
VA
Enumeration date
04/03/2014
Last updated
04/25/2015
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