MEDICARE: MS. ESMERALDA LOPEZ PT, DPT

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	225100000X	Physical Therapist	5308	OK

General Provider Information

NPI Number	:	1215458617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ESMERALDA LOPEZ PT, DPT

Provider Business Mailing Address
First Line	:	5937 N HAMMOND AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-7131
Country	:	US
Telephone Number	:	405-416-3078
Fax Number	:

Provider Business Practice Location Address
First Line	:	9210 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6902
Country	:	US
Telephone Number	:	405-759-7719
Fax Number	:

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	07/06/2017

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