MEDICARE: JEFFREY DAVID LOPEZ PT

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	PTH4514	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51530179	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1679593784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DAVID LOPEZ PT

Provider Business Mailing Address
First Line	:	2801 JOHN HAWKINS PKWY STE 141K
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4021
Country	:	US
Telephone Number	:	205-438-6683
Fax Number	:	659-234-7026

Provider Business Practice Location Address
First Line	:	2801 JOHN HAWKINS PKWY STE 141K
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-4021
Country	:	US
Telephone Number	:	205-438-6683
Fax Number	:	659-234-7026

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/24/2026

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Directions to “ JEFFREY DAVID LOPEZ PT” Practice Location

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