MEDICARE: PEDRO MIGUEL LOPEZ PTA

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	225200000X	Physical Therapy Assistant	PTA 23707	FL

General Provider Information

NPI Number	:	1952641276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO MIGUEL LOPEZ PTA

Provider Business Mailing Address
First Line	:	9874 SW 88TH ST
Second Line	:	APT G 202
City	:	MIAMI
State	:	FL
Zip	:	33176-1833
Country	:	US
Telephone Number	:	305-389-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	6808 SW 81ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143-7708
Country	:	US
Telephone Number	:	305-905-4188
Fax Number	:	305-595-6050

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

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	03/01/2013

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