Tidewater Physical Therapy, LLC
NPI 1477588986 · Physical Therapist · Glen Allen, VA
Enrolled with Medicare as Dme Supplier - Independently-Practicing Physical Therapist · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Tidewater Physical Therapy, LLC is a Physical Therapist organization in Glen Allen, VA (NPI 1477588986).
Provider details
- NPI number
- 1477588986
- 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
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
Registry dates
- Enumerated
- 2006-07-12
- Last updated
- 2024-11-25
- Certified
- 2024-11-25
Frequently asked questions
- What is Tidewater Physical Therapy, LLC's NPI number?
- Tidewater Physical Therapy, LLC's National Provider Identifier (NPI) is 1477588986, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Tidewater Physical Therapy, LLC?
- Tidewater Physical Therapy, LLC is classified in the NPPES registry as Physical Therapist (Respiratory, Developmental, Rehabilitative and Restorative Service Providers).
- Where is Tidewater Physical Therapy, LLC located?
- Tidewater Physical Therapy, LLC's practice location on file with NPPES is 10128 W Broad St, Glen Allen, VA 23060-6761.
- What is Tidewater Physical Therapy, LLC's phone number?
- The practice phone number listed in the NPPES registry for Tidewater Physical Therapy, LLC is (804) 217-9210.
- Does Tidewater Physical Therapy, LLC accept Medicare?
- Tidewater Physical Therapy, LLC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Tidewater Physical Therapy, LLC?
- The authorized official listed on Tidewater Physical Therapy, LLC's NPPES record is Tasheda Broughton, Manager, Credentialing. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Tidewater Physical Therapy, LLC's NPI active?
- Yes — Tidewater Physical Therapy, LLC's NPI (1477588986) is active in the NPPES registry as of the last update on 2024-11-25.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.