Dibacco, John M.

Dibacco, John M. is an individual health care provider with primary practice located at 911 Gorman Ave Ste 103, Elkins WV 26241-3154. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Dibacco, John M. can be contacted via phone (304) 636-1548.

Contact Information

Primary practice address
911 Gorman Ave Ste 103 Elkins WV 26241-3154
Fax: (304) 636-1566
Website:

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 001857 West Virginia

Profile Details

NPI number 1275536906
LBN Legal business name Dibacco, John M.
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 27th, 2005
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275536906 NPPES
West Virginia MEDICAID 0150180000

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