Provider Demographics
NPI:1710973441
Name:DIBIAS, BRIAN V (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:V
Last Name:DIBIAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0066
Mailing Address - Country:US
Mailing Address - Phone:330-759-2603
Mailing Address - Fax:330-759-2569
Practice Address - Street 1:3000 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1846
Practice Address - Country:US
Practice Address - Phone:330-759-2603
Practice Address - Fax:330-759-2569
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT08512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000329999OtherANTHEM
OH2083169Medicaid
PA241164OtherHEALTH ASSURANCE
PA1614855OtherHIGHMARK
OH2083169Medicaid