Provider Demographics
NPI:1083507313
Name:DIBACCO, JAY ANTHONY (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:ANTHONY
Last Name:DIBACCO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 KERR DR SE
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7776
Mailing Address - Country:US
Mailing Address - Phone:330-260-0304
Mailing Address - Fax:
Practice Address - Street 1:3119 CRANBERRY HWY UNIT 5
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4840
Practice Address - Country:US
Practice Address - Phone:508-759-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL88631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist