Tidewater Physical Therapy, LLC
NPI 1457389595 · Physical Therapist · Glen Allen, VA
Enrolled with Medicare as Part B Supplier - Physical/Occupational Therapy Group in Private Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1457389595
- Entity type
- Organization
- Primary specialty
- Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Organization subpart
- No
- Authorized official
- Tasheda Broughton, Manager, Credentialing(252) 248-3313
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Occupational Therapist225X00000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
- Speech-Language Pathologist235Z00000X
Speech, Language and Hearing Service Providers
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Pivot Physical Therapy of Virginia
Registry dates
- Enumerated
- 2006-06-29
- Last updated
- 2024-11-19
- Certified
- 2024-11-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.