Provider Demographics
NPI:1821024878
Name:MESISCA, DENNIS JOHN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JOHN
Last Name:MESISCA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7379
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7379
Mailing Address - Country:US
Mailing Address - Phone:714-281-0169
Mailing Address - Fax:714-281-2238
Practice Address - Street 1:27765 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3762
Practice Address - Country:US
Practice Address - Phone:714-281-0169
Practice Address - Fax:714-281-2238
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 168082251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT16808AMedicare PIN