Active NPI
Derrick Nzeakor, PTA
- Physical Therapy Assistant
- Mesquite, TX
National Provider Identifier
1306696885
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2127352
- Practice address
- 711 Matador LN
Mesquite, TX 75149-8830 - Phone
- (972) 532-0885
- NPI assigned
- Mar 26, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2127352 | TX | Primary |
Addresses
Primary practice location
711 Matador LN
Mesquite, TX 75149-8830
Mailing address
1311 Binfield Dr
Forney, TX 75126-3639
Phone (469) 952-0943
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2127352 | TX | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711411200000",
"number": "1306696885",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 BINFIELD DR",
"city": "FORNEY",
"state": "TX",
"postal_code": "751263639",
"telephone_number": "469-952-0943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "711 MATADOR LN",
"city": "MESQUITE",
"state": "TX",
"postal_code": "751498830",
"telephone_number": "972-532-0885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NZEAKOR",
"first_name": "DERRICK",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-03-26",
"last_updated": "2024-03-26",
"certification_date": "2024-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "TX",
"license": "2127352",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesquite, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.