Healthcare Provider Details

I. General information

NPI: 1538234810
Provider Name (Legal Business Name): TIDEWATER ORTHOPAEDIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 ENTERPRISE PKWY SUITE 900
HAMPTON VA
23666-6249
US

IV. Provider business mailing address

901 ENTERPRISE PKWY SUITE 900
HAMPTON VA
23666-6249
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2480
  • Fax:
Mailing address:
  • Phone: 757-827-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACEY TANNER BELL
Title or Position: CEO
Credential:
Phone: 757-827-2480