Provider Demographics
NPI:1003671454
Name:LOPEZ, JOHN (LMT,MLDT,MMP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:LMT,MLDT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 S FINLEY RD APT 313
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4356
Mailing Address - Country:US
Mailing Address - Phone:630-303-0010
Mailing Address - Fax:
Practice Address - Street 1:1910 S HIGHLAND AVE STE 260
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6129
Practice Address - Country:US
Practice Address - Phone:630-776-3043
Practice Address - Fax:630-929-1390
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.020840225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist