Healthcare Provider Details

I. General information

NPI: 1851555163
Provider Name (Legal Business Name): DIANNA BISHOP PT, DSC, CERT MDT, C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA L REINSEL

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 MEADE PKWY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-6300
  • Fax: 757-539-0704
Mailing address:
  • Phone: 919-373-2919
  • Fax: 410-648-4878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: