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

Tidewater Physical Therapy, LLC

Organization Physical Therapist · NPI 1093172181

Tidewater Physical Therapy, LLC is a Physical Therapist in Virginia Beach, Virginia. Registered with an NPI since 2016.

In the registry since
2016
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

1745 Camelot Dr Ste 100
Virginia Beach, VA 23454-2435
Phone: (757) 961-4800
Fax: (757) 961-0233
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

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

Record details

NPI number1093172181
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tasheda Broughton — Manger, Credentialing · (252) 248-3313
NPI enumeratedJanuary 21, 2016
Last updated in NPPESNovember 25, 2024
Certification dateNovember 25, 2024
Mailing address350 New Fidelity Ct, Garner, NC 27529-2665

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