MEDICARE: DIANA ELIZABETH NAUMANN PT, BSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	103226	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MA4370040	OTHER	MO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21304107	OTHER		BCBS KC

General Provider Information

NPI Number	:	1174560007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ELIZABETH NAUMANN PT, BSPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2564
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	10801 E STATE ROUTE 350 STE B
Second Line	:
City	:	RAYTOWN
State	:	MO
Zip	:	64138-2384
Country	:	US
Telephone Number	:	816-737-5502
Fax Number	:	816-737-5504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	05/08/2018

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Directions to “ DIANA ELIZABETH NAUMANN PT, BSPT” Practice Location

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