Healthcare Provider Details

I. General information

NPI: 1972483378
Provider Name (Legal Business Name): BRIAN LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 JOHN F KENNEDY DR STE 100
ATLANTIS FL
33462-6641
US

IV. Provider business mailing address

180 JOHN F KENNEDY DR STE 100
ATLANTIS FL
33462-6641
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43643
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: