MEDICARE: MR. CARLOS J LOPEZ LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA57224	FL

General Provider Information

NPI Number	:	1043549058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS J LOPEZ LMT

Provider Business Mailing Address
First Line	:	4711 W WATERS AVE APT 209
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1421
Country	:	US
Telephone Number	:	305-910-9832
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 N HIMES AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3139
Country	:	US
Telephone Number	:	813-877-9870
Fax Number	:	813-877-9869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2009
Last Update Date	:	01/25/2011

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