Healthcare Provider Details

I. General information

NPI: 1972419729
Provider Name (Legal Business Name): TESSA CHENAULT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 W BROAD ST
RICHMOND VA
23230-1732
US

IV. Provider business mailing address

6342 FOXROCK LN
MECHANICSVILLE VA
23111-4604
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606849
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: