Provider Demographics
NPI:1114114675
Name:MOYA, JENNIFER LOPEZ (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOPEZ
Last Name:MOYA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W. COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 116 C/O CHRISTINE ORTINO
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309
Mailing Address - Country:US
Mailing Address - Phone:954-332-4445
Mailing Address - Fax:954-332-4340
Practice Address - Street 1:8 THREE RIVERS COURT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4262
Practice Address - Country:US
Practice Address - Phone:302-836-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist