Healthcare Provider Details

I. General information

NPI: 1295733806
Provider Name (Legal Business Name): CHRISTINE LOPEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5481 SW 60TH STREET SUITE 102
OCALA FL
34471-5638
US

IV. Provider business mailing address

PO BOX 741708
ATLANTA GA
30374-1708
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-1122
  • Fax: 352-873-6841
Mailing address:
  • Phone: 352-382-7214
  • Fax: 352-382-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18014
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: