Healthcare Provider Details

I. General information

NPI: 1194138933
Provider Name (Legal Business Name): ELIZABETH J MEZZACAPPA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

IV. Provider business mailing address

1005 MIDWESTERN PKWY
WICHITA FALLS TX
76302-2211
US

V. Phone/Fax

Practice location:
  • Phone: 940-322-0771
  • Fax:
Mailing address:
  • Phone: 940-322-0771
  • Fax: 940-767-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4462
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1273020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: