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General NPI Number Information
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NPI Number | 1689775256
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Entity Type | Individual
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Provider Name | FAITH R LOPEZ PT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 11/15/2017
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Provider Practice Location Address
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Address Line | 5001 AMERICAN BLVD W STE 945
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1162
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Country | US
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Telephone | 952-835-6653
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 AMERICAN BLVD W STE 945
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City | BLOOMINGTON
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State | MN
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Zip | 55437-1162
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Country | US
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Telephone | 952-835-6653
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014022
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3732
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License Number State | AR
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