Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tidewater Physical Therapy, LLC

Organization Physical Therapist · NPI 1003114083

Tidewater Physical Therapy, LLC is a Physical Therapist in Richmond, Virginia. Licensed in Virginia. Registered with an NPI since 2011.

Licensed in
VA
In the registry since
2011
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

4831 S Laburnum Ave
Richmond, VA 23231-2713
Phone: (804) 222-0746
Fax: (804) 222-0728
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X (VA)
Occupational Therapist Taxonomy 225X00000X

Record details

NPI number1003114083
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tasheda Broughton — Manger, Credentialing · (252) 248-3313
NPI enumeratedMarch 1, 2011
Last updated in NPPESNovember 25, 2024
Certification dateNovember 25, 2024
Mailing address2122 York Rd Ste 300, Oak Brook, IL 60523-1925

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