Provider Demographics
NPI:1154130276
Name:TIDEWATER PELVIC HEALTH
Entity type:Organization
Organization Name:TIDEWATER PELVIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAROL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:757-503-5996
Mailing Address - Street 1:3705 N QUEENSGROVE CIR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3815
Mailing Address - Country:US
Mailing Address - Phone:757-503-5996
Mailing Address - Fax:
Practice Address - Street 1:3705 N QUEENSGROVE CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3815
Practice Address - Country:US
Practice Address - Phone:757-503-5996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy