Provider Demographics
NPI:1639328560
Name:MCCANN, DIANE ELIZABETH (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ELIZABETH
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:E
Other - Last Name:HUTCHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CSCS
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 1:154 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-2503
Practice Address - Country:US
Practice Address - Phone:757-797-0210
Practice Address - Fax:757-453-1550
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639328560OtherMEDICAID QMB
VAC05954OtherGROUP MEDICARE PTAN
VA004979796Medicaid
VAQ42044AMedicare PIN
VAC05954OtherGROUP MEDICARE PTAN