Individual provider Active NPI

Dominique Allyssa Velazquez, PT, DPT

  • Physical Therapist
  • Lanham, MD
National Provider Identifier
1902786106
Registry record updated Aug 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
30969 Issued in MD
Practice address
6710 Mallery Dr
Lanham, MD 20706-3964
Phone
(301) 552-2000
NPI assigned
Sep 8, 2025
Last updated
Aug 4, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
070.029410ILMDPhysical Therapist
30969MDMDPhysical Therapist
17561-24WIMDPhysical 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.

Verify at the official NPI Registry.