Healthcare Provider Details

I. General information

NPI: 1063340644
Provider Name (Legal Business Name): JOHN RUSSELL DIFABIO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET ST STE 110
CHAPEL HILL NC
27516-0448
US

IV. Provider business mailing address

1215 ANTLER RIDGE RD
ROUGEMONT NC
27572-6618
US

V. Phone/Fax

Practice location:
  • Phone: 984-528-8787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: