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 1457389595

Tidewater Physical Therapy, LLC is a Physical Therapist in Glen Allen, Virginia. Registered with an NPI since 2006.

In the registry since
2006
Specialties on file
4
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

10128 W Broad St Bldg Iii
Glen Allen, VA 23060-6761
Phone: (804) 217-9210
Fax: (804) 217-9213
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X
Occupational Therapist Taxonomy 225X00000X
Speech-Language Pathologist Taxonomy 235Z00000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1457389595
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tasheda Broughton — Manager, Credentialing · (252) 248-3313
Other names Pivot Physical Therapy Of Virginia
NPI enumeratedJune 29, 2006
Last updated in NPPESNovember 19, 2024
Certification dateNovember 19, 2024
Mailing address2122 York Rd Ste 300, Oak Brook, IL 60523-1925

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