MEDICARE: ROSALBA 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	227014889	IL

General Provider Information

NPI Number	:	1467861344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALBA LOPEZ LMT

Provider Business Mailing Address
First Line	:	1144 DOUGLAS RD
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-9040
Country	:	US
Telephone Number	:	630-554-9323
Fax Number	:

Provider Business Practice Location Address
First Line	:	1144 DOUGLAS RD
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-9040
Country	:	US
Telephone Number	:	630-554-9323
Fax Number	:

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

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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