Provider Demographics
NPI:1114170412
Name:LOPEZ, JOYCE T (PT)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:T
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 BELLEVILLE AVE
Mailing Address - Street 2:UNIT C-15
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1347
Mailing Address - Country:US
Mailing Address - Phone:201-388-2568
Mailing Address - Fax:
Practice Address - Street 1:731 BELLEVILLE AVE
Practice Address - Street 2:UNIT C-15
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1347
Practice Address - Country:US
Practice Address - Phone:201-388-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01011900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist