Individual
DIANE ELIZABETH MCCANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT, CSCS
Contact information
Practice address
154 E LITTLE CREEK RD, NORFOLK, VA 23505-2503
(757) 797-0210
(757) 453-1550
Mailing address
350 NEW FIDELITY CT, GARNER, NC 27529-2665
(919) 258-2714
(410) 648-4878
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305205658
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004979796
—
VA
01
—
1639328560
MEDICAID QMB
VA
01
—
C05954
GROUP MEDICARE PTAN
VA
Enumeration date
09/16/2008
Last updated
05/28/2020
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