Provider Demographics
NPI:1063552297
Name:CADDEN, TINA M (PT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CADDEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:1745 CAMELOT DR STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2435
Practice Address - Country:US
Practice Address - Phone:919-258-2714
Practice Address - Fax:410-648-4878
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004558225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA193437OtherANTHEM LOC 3
VA193431OtherANTHEM PT LOC 1
VAP00247140Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA193442OtherANTHEM LOC 5
VA249624OtherANTHEM PT LOC 6
VA005645L23Medicare ID - Type Unspecified
VAQ26442Medicare UPIN
VA193436OtherANTHEM PT LOC 2