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General NPI Number Information
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NPI Number | 1750009080
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Entity Type | Individual
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Provider Name | MATTHEW AURELIO LOPEZ PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1711 FRATE BARKER RD
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City | AUSTIN
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State | TX
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Zip | 78748-3600
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Country | US
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Telephone | 210-954-5609
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Fax |
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Provider Business Mailing Address
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Address Line | 14019 SUNNY GLN
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City | SAN ANTONIO
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State | TX
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Zip | 78217-1553
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Country | US
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Telephone | 210-954-5609
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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 | 1367331
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License Number State | TX
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