MEDICARE: CHRISTINE A 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	5210	NM

General Provider Information

NPI Number	:	1235398454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE A LOPEZ LMT

Provider Business Mailing Address
First Line	:	505 NATIONAL AVE STE 2
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4353
Country	:	US
Telephone Number	:	505-425-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 NATIONAL AVE STE 2
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4353
Country	:	US
Telephone Number	:	505-425-0500
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	02/23/2012

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