Tidewater Physical Therapy, Inc.
NPI 1790014629ActiveOrganization· Physical Therapist· Chesapeake, VA
Physical Therapist in Chesapeake, Virginia, registered in NPPES in December 2009. The authorized official on file is Tasheda Broughton, PESC, Manager, Credentialing.
Overview
| NPI | 1790014629 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 24, 2009 |
| Last updated in NPPES | Nov 25, 2024 |
| Certified by provider | Nov 25, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | — | VA |
| Occupational Therapist | 225X00000X | — | VA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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