Provider Demographics
NPI:1003598418
Name:AMAYA LOPEZ, RONALD (DPT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:AMAYA LOPEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3350
Mailing Address - Country:US
Mailing Address - Phone:631-404-9553
Mailing Address - Fax:
Practice Address - Street 1:322 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3008
Practice Address - Country:US
Practice Address - Phone:631-228-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist