MEDICARE: CHRISTINA JOY LOPEZ 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	027875	NY

General Provider Information

NPI Number	:	1912197732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA JOY LOPEZ PT

Provider Business Mailing Address
First Line	:	1601 3RD AVE
Second Line	:	APT 32J
City	:	NEW YORK
State	:	NY
Zip	:	10128-0030
Country	:	US
Telephone Number	:	631-965-6916
Fax Number	:	212-410-6402

Provider Business Practice Location Address
First Line	:	1601 3RD AVE
Second Line	:	APT 32J
City	:	NEW YORK
State	:	NY
Zip	:	10128-0030
Country	:	US
Telephone Number	:	631-965-6916
Fax Number	:	212-410-6402

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	09/22/2019

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