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General NPI Number Information
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NPI Number | 1083507313
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Entity Type | Individual
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Provider Name | JAY ANTHONY DIBACCO PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1725 HERITAGE TRL
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City | NAPLES
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State | FL
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Zip | 34112-8716
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Country | US
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Telephone | 508-759-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 3164 KERR DR SE
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-7776
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Country | US
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Telephone | 330-260-0304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTL88631
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License Number State | MA
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