Healthcare Provider Details

I. General information

NPI: 1639328560
Provider Name (Legal Business Name): DIANE ELIZABETH MCCANN PT, DPT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE E HUTCHINS PT, DPT, CSCS

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 E LITTLE CREEK RD
NORFOLK VA
23505-2503
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 757-797-0210
  • Fax: 757-453-1550
Mailing address:
  • Phone: 919-258-2714
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305205658
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: