Healthcare Provider Details

I. General information

NPI: 1699973867
Provider Name (Legal Business Name): BEATRIZ GEORGINA LOPEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WREN AVE
MIAMI SPRINGS FL
33166-3857
US

IV. Provider business mailing address

1100 WREN AVE
MIAMI SPRINGS FL
33166-3857
US

V. Phone/Fax

Practice location:
  • Phone: 786-322-8350
  • Fax: 305-882-0838
Mailing address:
  • Phone: 786-322-8350
  • Fax: 305-882-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number19353
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: