Provider Demographics
NPI:1821037789
Name:BOCLAIR, DIANNA (PT, DPT, GCS)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:BOCLAIR
Suffix:
Gender:F
Credentials:PT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 FLOYD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-3010
Mailing Address - Country:US
Mailing Address - Phone:804-741-0612
Mailing Address - Fax:804-740-0299
Practice Address - Street 1:1257 MARYWOOD LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6059
Practice Address - Country:US
Practice Address - Phone:804-741-0612
Practice Address - Fax:804-740-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI2305005496OtherVA LICENSE