Provider Demographics
NPI:1174560007
Name:NAUMANN, DIANA ELIZABETH (PT, BSPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ELIZABETH
Last Name:NAUMANN
Suffix:
Gender:F
Credentials:PT, BSPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:E
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:10801 E STATE ROUTE 350 STE B
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2384
Practice Address - Country:US
Practice Address - Phone:816-737-5502
Practice Address - Fax:816-737-5504
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21304107OtherBCBS KC
MOMA4370040OtherMEDICARE PTAN
MOK869048Medicare PIN