Healthcare Provider Details

I. General information

NPI: 1679593784
Provider Name (Legal Business Name): JEFFREY DAVID LOPEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 JOHN HAWKINS PKWY STE 141K
HOOVER AL
35244-4021
US

IV. Provider business mailing address

2801 JOHN HAWKINS PKWY STE 141K
HOOVER AL
35244-4021
US

V. Phone/Fax

Practice location:
  • Phone: 205-438-6683
  • Fax: 659-234-7026
Mailing address:
  • Phone: 205-438-6683
  • Fax: 659-234-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4514
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: