TIDEWATER PHYSICAL THERAPY, LLC (NPI# 1477588986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477588986 |
| Entity Type | Organization |
| Organization Name | TIDEWATER PHYSICAL THERAPY, LLC |
| Practice Address |
10128 W Broad St Forum Building IIi, Suite K Glen Allen VA 23060-6761 |
| Mailing Address |
350 New Fidelity Ct Garner NC 27529-2665 |
| Practice Telephone | 8042179210 |
| Practice Fax Number | 8042179213 |
| Mailing Telephone | 9192582714 |
| Mailing Fax Number | 4106484878 |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-05-05 |
| Authorized Official Name | PENNY PEARSON (RCM DIRECTOR) |
| Authorized Official Telephone | 4432254492 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | BCBS (PT) | 192953 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790270973 | Tidewater Physical Therapy, LLC | Physical Therapist | 392 Garrisonville Rd Ste 208, Stafford, VA 22554-1576 | 2018-06-29 |
| 1942703491 | Tidewater Physical Therapy, LLC | Physical Therapist | 872 Prices Fork Rd, Blacksburg, VA 24060-3229 | 2018-03-12 |
| 1609004571 | Tidewater Physical Therapy, LLC | Occupational Therapist | 3510 Anderson Hwy, Suite 2, Powhatan, VA 23139 | 2009-06-30 |
| 1669627048 | Tidewater Physical Therapy, LLC | Occupational Therapist | 10438 Iron Bridge Rd Unit 34, Chester, VA 23831-1427 | 2008-11-26 |
| 1265501696 | Tidewater Physical Therapy, LLC | Occupational Therapist | 2004 Sandbridge Rd, Suite 102, Virginia Beach, VA 23456-4084 | 2006-11-07 |
| 1821192220 | Tidewater Physical Therapy, LLC | Occupational Therapist | 227 Wadsworth Dr, Richmond, VA 23236-4510 | 2006-09-08 |
| 1942229901 | Tidewater Physical Therapy, LLC | Occupational Therapist | 4125 Ironbound Rd Ste 101, Williamsburg, VA 23188-2666 | 2006-07-19 |
| 1467471896 | Tidewater Physical Therapy, LLC | Occupational Therapist | 12494 Warwick Blvd, Newport News, VA 23606-3000 | 2006-07-18 |
| 1508898354 | Tidewater Physical Therapy, LLC | Occupational Therapist | 300 B Temple Lake Drive, Suite 1, Colonial Heights, VA 23834-2938 | 2006-07-06 |
| 1659887396 | Tidewater Physical Therapy, LLC | Physical Therapist | 4214 Fortuna Center Plz, Dumfries, VA 22025-1515 | 2017-12-18 |
| Street Address |
10128 W BROAD ST FORUM BUILDING III, SUITE K |
| City | GLEN ALLEN |
| State | VA |
| Zip Code | 23060-6761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891343513 | Anne Kim | Physical Therapist | 10128 W Broad St, Bldg 3, Ste K, Glen Allen, VA 23060 | 2019-08-27 |
| 1831548189 | Delanie Letard | Physical Therapist | 10128 W Broad St, Forum Bldg IIi, Suite K, Glen Allen, VA 23060-6761 | 2016-06-08 |
| 1699181669 | Platinum Pathology, Pllc | Clinical Medical Laboratory | 10128 W Broad St, Suite H, Glen Allen, VA 23060-6761 | 2014-07-10 |
| 1851645543 | Justin K Williams | Physical Therapist | 10128 W Broad St, Forum Building IIi, Suite K, Glen Allen, VA 23060-6761 | 2012-11-01 |
| 1497981161 | Matthew P Brennan | Physical Therapist | 10128 W Broad St, Forum Building IIi, Suite K, Glen Allen, VA 23060-6761 | 2009-06-08 |
| 1235394958 | William H Bowen | Physical Therapist | 10128 W Broad St, Forum Building IIi, Suite K, Glen Allen, VA 23060-6761 | 2008-07-22 |
| 1326167107 | Sherri Lee Rose | Nurse Practitioner | 10128 W Broad St, Suite J, Glen Allen, VA 23060-6761 | 2007-03-29 |
| 1003906793 | Gregory B Shasby | Physical Medicine & Rehabilitation | 10128 W Broad St, Forum Bldg IIi, Suite K, Glen Allen, VA 23060-6761 | 2006-10-13 |
| 1659398477 | Sirisha Brennan | Internal Medicine | 10128 W Broad St, Suite J, Glen Allen, VA 23060-6761 | 2006-07-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205469715 | Romy Sharieff | Midwife | 10433 Mountain Glen Pkwy, Glen Allen, VA 23060 | 2020-02-13 |
| 1366934549 | Guillermo Del Campo | Optometrist | 4114 Innslake Drive, Glen Allen, VA 23060 | 2018-06-04 |
| 1871013771 | Wecare Medical Transportation Inc. | Driver | 10524 Boscastle Rd, Glen Allen, VA 23060 | 2017-06-21 |
| 1265889570 | Darchelle Braxton Dmd PC | Dentist | 4300 Pouncey Tract Road Suite I, Glen Allen, VA 23060 | 2016-05-17 |
| 1952714842 | Gaynier Orthodontics PC | Clinic/Center | 4701 Cox Rx Ste 285, C/o Ct Corporation, Glen Allen, VA 23060 | 2014-06-09 |
| 1538507819 | Rca Laboratory Services, LLC | Clinical Medical Laboratory | 4060 Innslake Dr, Glen Allen, VA 23060 | 2013-06-10 |
| 1922352772 | Samantha S Stone | Physical Therapist | 4101 Cox Rd Ste 100, Glen Allen, VA 23060 | 2012-11-01 |
| 1609123660 | Stephanie Rene Matsko | Optometrist | 4114 Innslake Dr., Glen Allen, VA 23060 | 2012-08-09 |
| 1851661367 | Lateaka Sheri Vinson | Speech-Language Pathologist | 2250 Old Brick Rd, Suite 2229, Glen Allen, VA 23060 | 2012-01-01 |
| 1568774271 | Cynthia A Koza | Optometrist | 4600 Cox Road, Suite 120, Glen Allen, VA 23060 | 2010-07-10 |
| Find all providers in zip 23060 | ||||
| Taxonomy Code | 225100000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT’s assess joint motion, muscle strength and endurance, function of heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercises, cardiovascular endurance training, and training in activities of daily living. (2) A physical therapist is a person qualified by an accredited program in physical therapy, licensed by the state, and practicing within the scope of that license. Physical therapists treat disease, injury, or loss of a bodily part by physical means, such as the application of light, heat, cold, water, electricity, massage and exercise. They develop treatment plans based upon each patient’s strengths, weaknesses, range of motion and ability to function. (3) A health professional who specializes in physical therapy- the health care field concerned primarily with the treatment of disorders with physical agents and methods, such as massage, manipulation, therapeutic exercises, cold, heat (including short-wave, microwave, and ultrasonic diathermy), hydrotherapy, electric stimulation and light to assist in rehabilitating patients and in restoring normal function after an illness or injury. |
| Notes: Source: (1) APTA Guidelines for Physical Therapy Claims Review, American Physical Therapy Association. (3) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528683968 | Lauren Gough | Physical Therapist | 9980 Brook Rd # 16a, Glen Allen, VA 23059-6501 | 2020-06-11 |
| 1649810144 | Meredith Bowden | Physical Therapist | 4900 Dominion Blvd Ste B, Glen Allen, VA 23060-6773 | 2020-01-13 |
| 1467018556 | Prathyusha Gogineni | Physical Therapist | 11442 Abbots Cross Ln, Glen Allen, VA 23059-1103 | 2019-05-14 |
| 1215404496 | Heba Momin | Physical Therapist | 5050 Willows Green Rd, Glen Allen, VA 23059-5686 | 2018-10-25 |
| 1861918674 | Samantha Lynn Dealto | Physical Therapist | 5300 Hickory Park Dr Ste 110, Glen Allen, VA 23059-2629 | 2017-08-15 |
| 1366965923 | Jessica Lauren Napoleon | Physical Therapist | 4101 Cox Rd Ste 301, Glen Allen, VA 23060-3320 | 2017-07-25 |
| 1821522665 | Tanya Virani | Physical Therapist | 11612 Olde Covington Way, Glen Allen, VA 23059-5698 | 2017-04-19 |
| 1255728929 | Juee Shah | Physical Therapist | 2916 Ridgegate Pl, Glen Allen, VA 23059-4682 | 2015-04-21 |
| 1588058390 | Courtney Jones | Physical Therapist | 5252 Scotsglen Dr, Glen Allen, VA 23059-5533 | 2015-03-19 |
| 1285973669 | Paul S Palmieri | Physical Therapist | 6208 Isleworth Dr, Glen Allen, VA 23059-5426 | 2013-02-05 |
| Find all providers in GLEN ALLEN | ||||
| City | GLEN ALLEN |
| Zip Code | 23060 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.