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Tidewater Physical Therapy, LLC

Physical Therapist in Colonial Heights, VA · enumerated 2006 · authorized official Tasheda Broughton, Manager, Credentialing.

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

National Provider Identifier

1508898354

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Registry record

Entity type Organization (Type 2)
Legal business name Tidewater Physical Therapy, LLC
Practice address 300 B Temple Lake Drive, Suite 1, Colonial Heights, VA, 23834
Phone (804) 524-9036
Fax (804) 524-9039
Enumeration date Jul 6, 2006
Last updated in NPPES Nov 25, 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

Authorized official

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

Other identifiers

Identifier Type State Issuer
192947 Other VA ANTHEM BCBS (OT)

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 is the NPI number for Tidewater Physical Therapy, LLC?
The NPI for Tidewater Physical Therapy, LLC is 1508898354, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Tidewater Physical Therapy, LLC?
NPPES lists Tasheda Broughton (Manager, Credentialing) as the authorized official for this organization.

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2024-11-25.