Tidewater Physical Therapy, LLC
NPI 1790270973ActiveOrganization· Physical Therapist· Stafford, VA
Physical Therapist in Stafford, Virginia, registered in NPPES in June 2018. The authorized official on file is Tasheda Broughton, PESC, Manager, Credentialing.
Overview
| NPI | 1790270973 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 29, 2018 |
| 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 |
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) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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