Healthcare Provider Details

I. General information

NPI: 1821037789
Provider Name (Legal Business Name): DIANNA 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: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1257 MARYWOOD LN
RICHMOND VA
23229-6059
US

IV. Provider business mailing address

2804 FLOYD AVE
RICHMOND VA
23221-3010
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-0612
  • Fax: 804-740-0299
Mailing address:
  • Phone: 804-741-0612
  • Fax: 804-740-0299

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: