NPIMap

Individual provider Active NPI

Dillon Mezzacappa, DPT

  • Physical Therapist
  • Los Lunas, NM
National Provider Identifier
1881089233
Registry record updated Jul 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4595 Issued in NM
Practice address
2211 Main Street
Suite C
Los Lunas, NM 87031
Phone
(505) 866-1677
NPI assigned
Apr 2, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2015

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 4595 NM Primary

Addresses

Primary practice location

2211 Main Street
Suite C
Los Lunas, NM 87031

Mailing address

535 Highway 314 SW
Los Lunas, NM 87031-9600
Phone (505) 866-0055

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
4595NMMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
New Mexico Physical Therapists Dba Vibrantcare Past Accepting new patients
New Mexico Physical Therapists Inc Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1427932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437696000000",
    "number": "1881089233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 HIGHWAY 314 SW",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870319600",
            "telephone_number": "505-866-0055",
            "fax_number": "505-866-0057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 MAIN STREET",
            "address_2": "SUITE C",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "87031",
            "telephone_number": "505-866-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEZZACAPPA",
        "first_name": "DILLON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "4595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Lunas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.