Healthcare Provider Details

I. General information

NPI: 1710841093
Provider Name (Legal Business Name): SHEILA LOPEZ LMT, CLT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 E WATERVIEW PL
CHANDLER AZ
85249-6930
US

IV. Provider business mailing address

869 E WATERVEW PL
CHANDLER AZ
85249
US

V. Phone/Fax

Practice location:
  • Phone: 575-202-0627
  • Fax:
Mailing address:
  • Phone: 575-202-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT50318
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: