Tidewater Physical Therapy, LLC
Physical Therapist in Glen Allen, VA. Organization (NPI-2).
NPI number1457389595
StatusActive
Last updated in NPPESNov 19, 2024
Details
- NPI
- 1457389595
- Entity type
- Organization (NPI-2)
- Legal business name
- Tidewater Physical Therapy, LLC
- Organization subpart
- No
- Enumeration date
- Jun 29, 2006
- Certification date
- Nov 19, 2024
- Last updated
- Nov 19, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | – | – | Yes |
| 225X00000X | Occupational Therapist | – | – | |
| 235Z00000X | Speech-Language Pathologist, | – | – | |
| 261Q00000X | Clinic/Center | – | – |
Other names
- Pivot Physical Therapy Of Virginia (Doing Business As)
Practice location
10128 W Broad St Bldg IIIGlen Allen, VA 23060-6761
Phone 804-217-9210 · Fax 804-217-9213
Mailing address
2122 York Rd Ste 300Oak Brook, IL 60523-1925
Phone 252-248-3313 · Fax 410-648-4878
Authorized official
Tasheda Broughton
Manager, Credentialing
2522483313
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