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General NPI Number Information
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NPI Number | 1306404934
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Entity Type | Individual
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Provider Name | LAURA LOPEZ RODRIGUEZ I LMT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 3701 CONNECTICUT AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20008-4556
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Country | US
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Telephone | 240-601-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 8409 NEW HAMPSHIRE AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20783-2420
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Country | US
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Telephone | 240-601-4771
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | M04890
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019011796
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT2167
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License Number State | DC
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