<Unavail>

LBN: Tidewater Physical Therapy Llc
<Unavail> is an health care organization with primary practice located at 250 W Brambleton Ave Ste 100 , Norfolk VA 23510-1542. The organization recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as the primary health care specialty. Tidewater Physical Therapy Llc can be contacted via phone (757) 938-6608, or through Broughton, Tasheda via phone (252) 248-3313.

Contact Information

Primary practice address
250 W Brambleton Ave Ste 100 Norfolk VA 23510-1542
Phone: (757) 938-6608
Fax: (757) 938-6611
Website:
Map and Directions
Authorized official contact:
Name: Broughton, Tasheda PESC
Phone: (252) 248-3313

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X

Profile Details

NPI number 1538680400
LBN Legal business name Tidewater Physical Therapy Llc
DBA Doing business as <Unavail>
Authorized official Broughton, Tasheda PESC
Entity Organization
Organization subpart 1 No
Enumeration date Jun 30th, 2017
Last updated Nov 25th, 2024 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538680400 NPPES
Virginia Other C05954 MEDICARE GROUP PTAN

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