MEDICARE: MR. JOSEPH RALPH LOPEZ P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070012206	IL

General Provider Information

NPI Number	:	1437455540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH RALPH LOPEZ P.T.

Provider Business Mailing Address
First Line	:	5714 S RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2134
Country	:	US
Telephone Number	:	773-510-0739
Fax Number	:	872-207-5023

Provider Business Practice Location Address
First Line	:	5714 S RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2134
Country	:	US
Telephone Number	:	773-510-0739
Fax Number	:	872-207-5023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	06/06/2016

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