Healthcare Provider Details

I. General information

NPI: 1487585477
Provider Name (Legal Business Name): ALYSSA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 N WILMOT RD
TUCSON AZ
85712-3039
US

IV. Provider business mailing address

3201 E 26TH ST
TUCSON AZ
85713-2210
US

V. Phone/Fax

Practice location:
  • Phone: 520-300-6115
  • Fax:
Mailing address:
  • Phone: 808-896-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: