=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629571385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZANNE CHRISTINE LOPEZ DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2018
-----------------------------------------------------
Last Update Date | 10/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 945 E SHERMAN BLVD
-----------------------------------------------------
City | MUSKEGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49444-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-737-4374
-----------------------------------------------------
Fax | 231-830-9196
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1377 MOTOR PKWY STE 307
-----------------------------------------------------
City | ISLANDIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11749-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-580-5200
-----------------------------------------------------
Fax | 631-580-5222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501017160
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------