MEDICARE: GIANNA LOPES PTA

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	225200000X	Physical Therapy Assistant	A5616	MD
2	225200000X	Physical Therapy Assistant	4401	SC

General Provider Information

NPI Number	:	1558021550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIANNA LOPES PTA

Provider Business Mailing Address
First Line	:	20A SMITH BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6093
Country	:	US
Telephone Number	:	843-251-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	176 VILLAGE CENTER BLVD
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-6618
Country	:	US
Telephone Number	:	843-547-5272
Fax Number	:

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

Provider Enumeration Date	:	12/19/2021
Last Update Date	:	04/30/2022

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Directions to “ GIANNA LOPES PTA” Practice Location

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