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General NPI Number Information
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NPI Number | 1154130276
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Entity Type | Organization
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Legal Business Name | TIDEWATER PELVIC HEALTH
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 3705 N QUEENSGROVE CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3815
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Country | US
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Telephone | 757-503-5996
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 N QUEENSGROVE CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3815
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Country | US
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Telephone | 757-503-5996
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, OWNER
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Name | MEGHAN KAROL
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Credential | DPT
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Telephone | 757-503-5996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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