Tidewater Physical Therapy, LLC
NPI 1457389595ActiveOrganization· Physical Therapist· Glen Allen, VA
Physical Therapist in Glen Allen, Virginia, registered in NPPES in June 2006. The authorized official on file is Tasheda Broughton, PESC, Manager, Credentialing. Enrolled in Medicare as part b supplier - physical/occupational therapy group in private practice and part b supplier - physical/occupational therapy group in private practice.
Overview
| NPI | 1457389595 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 29, 2006 |
| Last updated in NPPES | Nov 19, 2024 |
| Certified by provider | Nov 19, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Occupational Therapist | 225X00000X | — | — |
| Speech-Language Pathologist | 235Z00000X | — | — |
| Clinic/Center | 261Q00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Physical/Occupational Therapy Group in Private Practice (DC); Part B Supplier - Physical/Occupational Therapy Group in Private Practice (VA) |
|---|
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