Individual
JOHN M. DIBACCO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
911 GORMAN AVE, STE 103, ELKINS, WV 26241-3154
(304) 636-1548
(304) 636-1566
Mailing address
911 GORMAN AVE, STE 103, ELKINS, WV 26241-3154
(304) 636-1548
(304) 636-1566
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001857
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0150180000
—
WV
Enumeration date
05/27/2005
Last updated
07/08/2007
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