Healthcare Provider Details

I. General information

NPI: 1821037789
Provider Name (Legal Business Name): DIANNA M BOCLAIR P.T., DPT, GCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 ASTLEY TER
MIDLOTHIAN VA
23114-4506
US

IV. Provider business mailing address

1312 ASTLEY TER
MIDLOTHIAN VA
23114-4506
US

V. Phone/Fax

Practice location:
  • Phone: 804-651-1170
  • Fax: 610-335-4443
Mailing address:
  • Phone: 804-651-1170
  • Fax: 610-335-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: