Provider Demographics
NPI:1093360067
Name:LOPEZ, KIMBERLY ALYCE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALYCE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 JONES MALTSBERGER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4215
Mailing Address - Country:US
Mailing Address - Phone:210-590-4000
Mailing Address - Fax:210-590-4585
Practice Address - Street 1:9618 HUEBNER RD STE 219
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1776
Practice Address - Country:US
Practice Address - Phone:210-714-5810
Practice Address - Fax:210-714-5811
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist