Healthcare Provider Details

I. General information

NPI: 1609922657
Provider Name (Legal Business Name): LUCILLE LOPEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 MARNA LYNN AVE NW PETROGLYPH ES
ALBUQUERQUE NM
87114-5701
US

IV. Provider business mailing address

6400 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4202
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-0923
  • Fax:
Mailing address:
  • Phone: 505-855-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1507
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: