MEDICARE: ELISA LOPEZ MARTINEZ PT

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	25294	MD
2	225100000X	Physical Therapist	61971	OR
3	225100000X	Physical Therapist	10092284-2401	UT
4	225100000X	Physical Therapist	3447	NV
5	225100000X	Physical Therapist	137467	AK

General Provider Information

NPI Number	:	1508381450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA LOPEZ MARTINEZ PT

Provider Business Mailing Address
First Line	:	PO BOX 31001-4162
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4162
Country	:	US
Telephone Number	:	866-747-2455
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W NORTHERN LIGHTS BLVD STE A
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3652
Country	:	US
Telephone Number	:	907-212-2090
Fax Number	:

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	06/02/2026

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Directions to “ ELISA LOPEZ MARTINEZ PT” Practice Location

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