Active NPI
Dominique Allyssa Velazquez, PT, DPT
- Physical Therapist
- Lanham, MD
National Provider Identifier
1902786106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 30969
- Practice address
- 6710 Mallery Dr
Lanham, MD 20706-3964 - Phone
- (301) 552-2000
- NPI assigned
- Sep 8, 2025
- Last updated
- Aug 4, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.029410 | IL | |
| Physical Therapist | 225100000X | 17561-24 | WI | |
| Physical Therapist | 225100000X | 30969 | MD | Primary |
Addresses
Primary practice location
6710 Mallery Dr
Lanham, MD 20706-3964
Mailing address
18881 W Dodge Rd Ste 300W
Elkhorn, NE 68022-4648
Other practice location 1
611 W Park St
Urbana, IL 61801-2529
Phone (217) 383-3311
Other practice location 2
333 Pine Ridge Blvd
Wausau, WI 54401-4187
Phone (715) 847-2121
Other practice location 3
18881 W Dodge Rd Ste 300W
Elkhorn, NE 68022-4648
Phone (877) 230-3885
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 |
|---|---|---|---|
| 070.029410 | IL | MD | Physical Therapist |
| 30969 | MD | MD | Physical Therapist |
| 17561-24 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785801600000",
"number": "1902786106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18881 W DODGE RD STE 300W",
"city": "ELKHORN",
"state": "NE",
"postal_code": "680224648"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6710 MALLERY DR",
"city": "LANHAM",
"state": "MD",
"postal_code": "207063964",
"telephone_number": "301-552-2000"
}
],
"practiceLocations": [
{
"address_1": "611 W Park St",
"address_purpose": "LOCATION",
"city": "Urbana",
"state": "IL",
"postal_code": "618012529",
"country_code": "US",
"telephone_number": "217-383-3311",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "333 Pine Ridge Blvd",
"address_purpose": "LOCATION",
"city": "Wausau",
"state": "WI",
"postal_code": "544014187",
"country_code": "US",
"telephone_number": "715-847-2121",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "18881 W Dodge Rd Ste 300W",
"address_purpose": "LOCATION",
"city": "Elkhorn",
"state": "NE",
"postal_code": "680224648",
"country_code": "US",
"telephone_number": "877-230-3885",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VELAZQUEZ",
"first_name": "DOMINIQUE",
"middle_name": "ALLYSSA",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-08",
"last_updated": "2026-08-04",
"certification_date": "2026-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.029410",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "17561-24",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "30969",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lanham, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.