Healthcare Provider Details

I. General information

NPI: 1063226009
Provider Name (Legal Business Name): IRAIDA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 NE 167TH ST
NORTH MIAMI BEACH FL
33162-2304
US

IV. Provider business mailing address

19653 SW 133RD CT
MIAMI FL
33177-4274
US

V. Phone/Fax

Practice location:
  • Phone: 786-613-3269
  • Fax:
Mailing address:
  • Phone: 786-219-8953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: