MEDICARE: JESLY 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	2251N0400X	Neurology Physical Therapist	1214416	TX

General Provider Information

NPI Number	:	1912247032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESLY LOPEZ PT

Provider Business Mailing Address
First Line	:	12055 SABO RD APT 1017
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6290
Country	:	US
Telephone Number	:	786-256-9319
Fax Number	:

Provider Business Practice Location Address
First Line	:	12055 SABO RD APT 1017
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-6290
Country	:	US
Telephone Number	:	786-256-9319
Fax Number	:

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

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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Directions to “ JESLY LOPEZ PT” Practice Location

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