Provider Demographics
NPI:1205011418
Name:LOPEZ VEGA, ORLANDO O (MSPT, PT)
Entity Type:Individual
Prefix:
First Name:ORLANDO
Middle Name:O
Last Name:LOPEZ VEGA
Suffix:
Gender:M
Credentials:MSPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VILLA BORINQUEN
Mailing Address - Street 2:BUZON 389
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:939-642-0507
Mailing Address - Fax:787-896-0459
Practice Address - Street 1:URB. VILLA BORINQUEN
Practice Address - Street 2:BUZON 389
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:939-642-0507
Practice Address - Fax:787-896-0459
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist