Provider Demographics
NPI:1093290231
Name:LOPEZ, CHRISTIAN ADOLFO (PTA)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ADOLFO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:CRISTIAN
Other - Middle Name:ADOLFO
Other - Last Name:LOPEZ-MAGANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3115 NEW CASTLE AVE TRLR 5
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2168
Mailing Address - Country:US
Mailing Address - Phone:302-464-9635
Mailing Address - Fax:
Practice Address - Street 1:33 DEAK DR STE 101
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1268
Practice Address - Country:US
Practice Address - Phone:302-659-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0001281225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant