Individual
DIANE G WASSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
101 E WT HARRIS BLVD, SUITE 300, CHARLOTTE, NC 28262-3485
(704) 548-5780
(704) 578-5876
Mailing address
1100 BLYTHE BLVD, CHARLOTTE, NC 28203-5814
(704) 355-4370
(704) 355-4231
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1602
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079AY
BCBS NC
NC
05
—
7211897
—
NC
Enumeration date
08/01/2006
Last updated
07/09/2007
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