Provider Demographics
NPI:1508847591
Name:EPPLEIN, DIANNE ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:ELLEN
Last Name:EPPLEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DIANNE
Other - Middle Name:ELLEN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:818 NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1116
Mailing Address - Country:US
Mailing Address - Phone:757-473-8016
Mailing Address - Fax:757-473-3580
Practice Address - Street 1:818 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1116
Practice Address - Country:US
Practice Address - Phone:757-473-8016
Practice Address - Fax:757-473-3580
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305 000587225100000X
225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
64 00313OtherUNITED HEALTH CARE
35062OtherOPTIMA
5369690OtherAETNA
5275769OtherAETNA GROUP
436752OtherANTHEM BLUE CROSS
007328OtherANTHEM BLUE CROSS GROUP
4980093OtherVIRGINIA PREMIER HEALTH P
VA4980093Medicaid
11230312OtherCAQH
350034OtherOPTIMA GROUP
VA9116460OtherMEDICAID
5275769OtherAETNA GROUP