TIDEWATER PHYSICAL THERAPY, LLC
NPI 1477588986
Physical Therapist in Glen Allen, VA
About Tidewater Physical Therapy, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TIDEWATER PHYSICAL THERAPY, LLC (NPI 1477588986) is a healthcare organization registered as a physical therapist in Glen Allen, Virginia and active in the NPI registry since July 2006. The organization lists Tasheda Broughton, Manager, Credentialing, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
- Diagnose and manage movement dysfunction and enhance physical and functional abilities.
- Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
- Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
- Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
- Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Tidewater Physical Therapy, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
379Medicare enrollment records show 379 clinicians reassign Medicare billing to Tidewater Physical Therapy, LLC, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 54 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 3
Nearest to this location (20)
See all 379Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tidewater Physical Therapy, LLC's NPI number?
The NPI number for Tidewater Physical Therapy, LLC is 1477588986. It was assigned to this organization in the NPPES registry on July 12, 2006.
Where is Tidewater Physical Therapy, LLC located?
Tidewater Physical Therapy, LLC is located at 10128 W Broad St Forum Building III, Suite K, Glen Allen, VA 23060. The listed phone number is (804) 217-9210.
What is Tidewater Physical Therapy, LLC's specialty?
The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.
Is Tidewater Physical Therapy, LLC enrolled in Medicare?
Yes. Tidewater Physical Therapy, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Tidewater Physical Therapy, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 379 clinicians in 3 Medicare specialties reassign their Medicare billing to Tidewater Physical Therapy, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Physical Therapist in Private Practice (374), Occupational Therapist in Private Practice (4) and Qualified Speech Language Pathologist (1). Of these, 6 practice at this address and 54 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Tidewater Physical Therapy, LLC was last updated on November 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Tidewater Physical Therapy, Llc · NPI 1477588986
Physical Therapist organization in Glen Allen, Virginia. Organization record, active in the CMS NPPES registry since July 12, 2006.
## Identity
- **NPI:** 1477588986 (Entity type: Organization)
- **Enumerated:** July 12, 2006
- **Primary specialty:** Physical Therapist · taxonomy 225100000X
- **Organization subpart:** No
- **Authorized official:** Tasheda Broughton, MANAGER, CREDENTIALING
## Practice location
- **Address:** 10128 W BROAD ST, FORUM BUILDING III, SUITE K, Glen Allen, VA 23060-6761
- **Phone:** (804) 217-9210 · **Fax:** (804) 217-9213
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 379 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Physical Therapist in Private Practice (374), Occupational Therapist in Private Practice (4), Qualified Speech Language Pathologist (1); 6 practice at this address and 54 within 10 miles; [full list](https://npiprofile.com/npi/1477588986/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 25, 2024
- **Other identifiers:** Other 192953 (VA)
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Source: [NPI Profile](https://npiprofile.com/npi/1477588986) · Data from the CMS NPPES public registry.