OrganizationTidewater Physical Therapy Llc(<Unavail>)Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address10518 Spotsylvania Ave Ste 100, Fredericksburg, VA 22408-2693(540) 710-5341(252) 248-3313PECOS EnrollmentBased on the most recent information from CMS, provider Tidewater Physical Therapy Llc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1427561984Provider TypeOrganizationFull NameTidewater Physical Therapy LlcOther Name<Unavail>SubpartNoEnumeration Date11/7/2017Last Updated11/25/2024Contact InformationPractice LocationPractice Address10518 Spotsylvania Ave Ste 100, Fredericksburg, VA 22408-2693Phone(540) 710-5341Fax(540) 710-5372Mailing LocationMailing Address2122 York Rd Ste 300, Oak Brook, IL 60523-1925Phone(252) 248-3313Fax(410) 648-4878Authorized OfficialNameBroughton, Tasheda (Manager, Credentialing)Phone(252) 248-3313Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDC05954DescriptionOtherIssuerGROUP MEDICARE PTANVirginia