Healthcare Provider Details

I. General information

NPI: 1184166092
Provider Name (Legal Business Name): PAULA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W 6TH ST
WILMINGTON DE
19805-1828
US

IV. Provider business mailing address

17059 COMMONS CREEK DR
CHARLOTTE NC
28277-2080
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-6135
  • Fax:
Mailing address:
  • Phone: 704-421-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0001084
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055654
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: