Healthcare Provider Details

I. General information

NPI: 1609650407
Provider Name (Legal Business Name): NAOMI SHELA LOPEZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PLEASANT VALLEY WAY
WEST ORANGE NJ
07052-1424
US

IV. Provider business mailing address

70 OAK ST APT 201
EAST RUTHERFORD NJ
07073-1254
US

V. Phone/Fax

Practice location:
  • Phone: 973-414-4711
  • Fax:
Mailing address:
  • Phone: 551-221-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number40QA2191000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: