Individual provider Active NPI

Roy Mendizabal

  • Physical Therapist
  • Dalton, GA
National Provider Identifier
1639917719
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1343 W Walnut Ave
Dalton, GA 30720-3857
Phone
(706) 913-8201
Fax
(706) 459-3646
NPI assigned
Jul 15, 2024
Last updated
Oct 1, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X GA Primary

Addresses

Primary practice location

1343 W Walnut Ave
Dalton, GA 30720-3857

Mailing address

2001 Butterfield Rd Ste 1600
Downers Grove, IL 60515-1211
Phone (630) 296-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, AL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240815003763 GA Practitioner - Physical Therapist in Private Practice 6507304961 Reassigns benefits to 1 organization
I20260612000100 AL Practitioner - Physical Therapist in Private Practice 6507304961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ati Holdings of Alabama LLCGroup PAC ID 2769756436, 66 clinicians

Practice addresses (Care Compare)

50 Commons Way
Suite D
Oxford, AL 36203-3490
Phone (256) 624-9722

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
MCM Rehabilitation, LLC. Physical Therapist CurrentSince Jul 15, 2024 Accepting new patients
MCM Rehabilitation LLC CurrentSince Jul 15, 2024 Accepting new patients

Locations

1343 W Walnut Ave
Dalton, GA 30720
Phone (706) 913-8201

97 Gateway Business Park Dr
Ringgold, GA 30736
Phone (706) 937-5771

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cr
Chicago, IL 60674

2001 Butterfield Rd
Ste 1600
Downers Grove, IL 60515

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790812800000",
    "number": "1639917719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 BUTTERFIELD RD STE 1600",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605151211",
            "telephone_number": "630-296-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1343 W WALNUT AVE",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307203857",
            "telephone_number": "706-913-8201",
            "fax_number": "706-459-3646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDIZABAL",
        "first_name": "ROY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-15",
        "last_updated": "2026-10-01",
        "certification_date": "2026-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dalton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.