Healthcare Provider Details

I. General information

NPI: 1114776036
Provider Name (Legal Business Name): ANA CRISTINA LOPEZ GOMEZ DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 W I 20
ARLINGTON TX
76017-1057
US

IV. Provider business mailing address

3824 S CARRIER PKWY STE 490
GRAND PRAIRIE TX
75052-6668
US

V. Phone/Fax

Practice location:
  • Phone: 817-561-1115
  • Fax: 817-516-1104
Mailing address:
  • Phone: 972-262-9972
  • Fax: 972-262-9986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1397376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: