Healthcare Provider Details

I. General information

NPI: 1154130276
Provider Name (Legal Business Name): TIDEWATER PELVIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 N QUEENSGROVE CIR
VIRGINIA BEACH VA
23452-3815
US

IV. Provider business mailing address

3705 N QUEENSGROVE CIR
VIRGINIA BEACH VA
23452-3815
US

V. Phone/Fax

Practice location:
  • Phone: 757-503-5996
  • Fax:
Mailing address:
  • Phone: 757-503-5996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN KAROL
Title or Position: PHYSICAL THERAPIST, OWNER
Credential: DPT
Phone: 757-503-5996