Provider Demographics
NPI:1225256936
Name:LOPEZ, ELVIS E (DPT)
Entity Type:Individual
Prefix:
First Name:ELVIS
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12519 53RD RD N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-9001
Mailing Address - Country:US
Mailing Address - Phone:561-809-3653
Mailing Address - Fax:561-498-0733
Practice Address - Street 1:12519 53RD RD N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-9001
Practice Address - Country:US
Practice Address - Phone:561-900-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22428OtherFLORIDA LICENSE