Tidewater Physical Therapy, LLC
NPI 1477588986ActiveOrganization· Physical Therapist· Glen Allen, VA
Physical Therapist in Glen Allen, Virginia, registered in NPPES in July 2006. The authorized official on file is Tasheda Broughton, PESC, Manager, Credentialing. Enrolled in Medicare as dme supplier - independently-practicing physical therapist.
Overview
| NPI | 1477588986 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 12, 2006 |
| Last updated in NPPES | Nov 25, 2024 |
| Certified by provider | Nov 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | — |
| Occupational Therapist | 225X00000X | — | — |
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 DME Supplier - Independently-Practicing Physical Therapist (VA) |
|---|
Other Physical Therapist providers in Glen Allen
- 1548676307
- 1922724780
- 1083614473
- 1851484448
- 1013054782
- 1457068595
- 1497204630
- 1760434948
- 1801915194
- 1386679595
- 1457389595
- 1013885771