Healthcare Provider Details

I. General information

NPI: 1700570496
Provider Name (Legal Business Name): JOAO LOPES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 TOEPPERWEIN RD STE 120
LIVE OAK TX
78233-3208
US

IV. Provider business mailing address

1626 N ELLISON DR APT NO08203
SAN ANTONIO TX
78251-4206
US

V. Phone/Fax

Practice location:
  • Phone: 210-653-4420
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1377571
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: