Provider Demographics
NPI:1033171566
Name:LOPEZ, LEILANI A (PT)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY
Mailing Address - Street 2:STE 307
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:667 STONELEIGH AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2454
Practice Address - Country:US
Practice Address - Phone:845-230-5178
Practice Address - Fax:845-363-1816
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY019000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400090510Medicare PIN
NYWCJ511Medicare PIN