Tidewater Physical Therapy, LLC
Tidewater Physical Therapy, LLC is a healthcare organization registered as Physical Therapist in Gloucester, VA, holding Type 2 (organization) NPI 1619992872 since 2006. The authorized official on file is Tasheda Broughton, Manager, Credentialing.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1619992872 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Tidewater Physical Therapy, LLC |
| Practice address | 6970 FOX HUNT LN, Gloucester, VA, 23061 |
| Phone | 8046948111 |
| Fax | 8046945574 |
| Enumeration date | 2006-07-12 |
| Last updated in NPPES | 2024-11-25 |
Authorized official
| Name | Tasheda Broughton |
|---|---|
| Title | Manager, Credentialing |
| Phone | 2522483313 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 225X00000X | Occupational Therapist | Secondary | — | — |
| 225100000X | Physical Therapist | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 192960 | Other | VA | BCBS (PT) |
| 223951103 | Other | VA | DOL |
Copy-ready billing details
Provider: Tidewater Physical Therapy, LLC NPI: 1619992872 Taxonomy: 225100000X (Physical Therapist) Address: 6970 FOX HUNT LN, Gloucester, VA, 23061
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1891756722 | Pamela Witthaus | Individual | Occupational Therapist | Gloucester, VA |
| 1306807375 | Natalie Conway | Individual | Physical Therapist | Gloucester, VA |
| 1649232893 | Amy Beatty | Individual | Physical Therapist | Gloucester, VA |
| 1710923776 | Steven Wilde | Individual | Physical Therapist | Gloucester, VA |
| 1821348426 | Erin Jasenak | Individual | Physical Therapist | Gloucester, VA |
| 1518393099 | Richard Sieller | Individual | Physical Therapist | Gloucester, VA |
| 1801275060 | Joan Tomas | Individual | Physical Therapist | Gloucester, VA |
| 1225511918 | William Clinger | Individual | Physical Therapist | Gloucester, VA |
Verify this record
Cross-check NPI 1619992872 against the authoritative CMS record: view Tidewater Physical Therapy, LLC on the official NPPES registry .
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. Read the full guide or validate an NPI number.
Frequently asked questions
Where is Tidewater Physical Therapy, LLC located?
How current is this record?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2024-11-25.