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General NPI Number Information
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NPI Number | 1558550616
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Entity Type | Individual
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Provider Name | ROBERTO LOPEZ DPT
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Gender | Male
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 747 S STATE ROAD 7
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City | PLANTATION
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State | FL
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Zip | 33317-4055
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Country | US
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Telephone | 954-316-1131
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Fax |
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Provider Business Mailing Address
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Address Line | 520 NE 20TH ST APT 404
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City | WILTON MANORS
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State | FL
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Zip | 33305-2151
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Country | US
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Telephone | 954-591-5557
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Fax | 954-678-9116
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT23628
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License Number State | FL
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