Provider Demographics
NPI:1114027158
Name:LOPEZ, AMY MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:REOHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7687 FRONTAGE RD
Mailing Address - Street 2:ATTN KELLY STEELE
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8921
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-635-3663
Practice Address - Street 1:800 CARTER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-338-1400
Practice Address - Fax:585-336-4845
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP0140059WHOtherBLUE CHOICE
NY00355266Medicaid
NY9314146OtherIHA
NY5361OtherSIDNEY HILLMAN
NYFA0501OtherPREFERRED CARE