Provider Demographics
NPI:1851555163
Name:BISHOP, DIANNA (PT, DSC, CERT MDT, C)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PT, DSC, CERT MDT, C
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:L
Other - Last Name:REINSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:919-373-2919
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2007 MEADE PKWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-539-6300
Practice Address - Fax:757-539-0704
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1851555163OtherMEDICAID QMB
VA004979796Medicaid
VAC05954OtherMEDICARE GROUP NUMBER
VA496633Medicare PIN
VAQ45423AMedicare PIN