Healthcare Provider Details

I. General information

NPI: 1689554735
Provider Name (Legal Business Name): RYAN DILEGGE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST
SPENCER MA
01562-2691
US

IV. Provider business mailing address

133 W MAIN ST
SPENCER MA
01562-2691
US

V. Phone/Fax

Practice location:
  • Phone: 774-449-8058
  • Fax: 774-449-8092
Mailing address:
  • Phone: 774-449-8058
  • Fax: 774-449-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL88500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: