Healthcare Provider Details

I. General information

NPI: 1295664233
Provider Name (Legal Business Name): MORGAN LEE LOPEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12055 PERSIMMON TER STE 130
AUBURN CA
95603-3808
US

IV. Provider business mailing address

18840 DOG BAR RD
GRASS VALLEY CA
95949-9513
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-0478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number50297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: