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Tidewater Physical Therapy, LLC

Physical Therapist in Glen Allen, VA · enumerated 2006 · authorized official Tasheda Broughton, Manager, Credentialing.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1457389595

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Registry record

Entity type Organization (Type 2)
Legal business name Tidewater Physical Therapy, LLC
Other name <Unavail>
Practice address 10128 W Broad St Bldg III, Glen Allen, VA, 23060
Phone (804) 217-9210
Fax (804) 217-9213
Enumeration date Jun 29, 2006
Last updated in NPPES Nov 19, 2024

Taxonomy & classification

225100000X Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers Primary
225X00000X Occupational Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers Secondary
235Z00000X Speech-Language Pathologist Speech, Language and Hearing Service Providers Secondary
261Q00000X Clinic/Center Ambulatory Health Care Facilities Secondary

Authorized official

Name Tasheda Broughton
Title Manager, Credentialing
Phone (252) 248-3313

Other identifiers

Identifier Type State Issuer
C12068 Other VA MEDICARE RAILROAD

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What type of organization is Tidewater Physical Therapy, LLC?
Tidewater Physical Therapy, LLC is registered in NPPES as a Physical Therapist (its primary provider taxonomy).
What is a Type 2 NPI?
A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2024-11-19.