TIDEWATER PHYSICAL THERAPY, LLC – Physical Therapist, NPI 1366477564

TIDEWATER PHYSICAL THERAPY, LLC is a healthcare provider. based in Oak brook, Illinois. specializing in Physical Therapist. The NPI Number for TIDEWATER PHYSICAL THERAPY, LLC is 1366477564

Main info

Organization
Name
TIDEWATER PHYSICAL THERAPY, LLC
NPI
1366477564
Phone
(252) 248-3313
Address
2122 YORK RD STE 300
Authorized Official
TASHEDA BROUGHTON MANAGER, CREDENTIALING PESC
Enumeration Date
12 July 2006
Last Update Date
25 November 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience58
Completeness75
Years active:19State licenses:0Digital endpointsOther names

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Provider Addresses for TIDEWATER PHYSICAL THERAPY, LLC

  • 2122 YORK RD STE 300

    OAK BROOK, IL 605231925

    Phone: (252) 248-3313

    Fax: (410) 648-4878

    Type: Mailing

  • 6161, Kempsville Circle, Glen Rock, Janaf, Norfolk, Virginia, 23502, United States

    SUITE 250

    NORFOLK, VA 235023932

    Phone: (757) 965-4890

    Fax: (757) 965-4893

    Type: Location

  • New Fidelity Court, Garner, Wake County, North Carolina, 275, United States

    GARNER, NC 275292665

    Phone: (919) 258-2714

    Fax: (410) 648-4878

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60523)

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Reviews

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Frequently asked questions

How is TIDEWATER PHYSICAL THERAPY, LLC identified in CMS data?
CMS-hosted NPPES data lists TIDEWATER PHYSICAL THERAPY, LLC with NPI 1366477564.
Does the file indicate TIDEWATER PHYSICAL THERAPY, LLC is practicing under active NPI?
Directory data currently reports TIDEWATER PHYSICAL THERAPY, LLC as active.
What taxonomy line describes TIDEWATER PHYSICAL THERAPY, LLC?
For research purposes, treat TIDEWATER PHYSICAL THERAPY, LLC as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
What area does TIDEWATER PHYSICAL THERAPY, LLC serve?
TIDEWATER PHYSICAL THERAPY, LLC's listing highlights Oak Brook, Illinois; more addresses can appear in NPPES.
Why does TIDEWATER PHYSICAL THERAPY, LLC have multiple addresses?
3 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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