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NPI Code Detail

MEDICARE: JAY ANTHONY DIBACCO PT, DPT

MEDICARE: JAY ANTHONY DIBACCO PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPTL88631MA

General Provider Information

NPI Number : 1083507313
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY ANTHONY DIBACCO PT, DPT
Provider Business Mailing Address
First Line : 3164 KERR DR SE
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663-7776
Country : US
Telephone Number : 330-260-0304
Fax Number :
Provider Business Practice Location Address
First Line : 1725 HERITAGE TRL
Second Line :
City : NAPLES
State : FL
Zip : 34112-8716
Country : US
Telephone Number : 508-759-5411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2025
Last Update Date : 12/29/2025

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