Provider Demographics
NPI:1265636120
Name:LOPEZ, DANIEL (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
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 1:3 HORTON PL
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1745
Mailing Address - Country:US
Mailing Address - Phone:207-798-6921
Mailing Address - Fax:207-798-6829
Practice Address - Street 1:3 HORTON PL
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1745
Practice Address - Country:US
Practice Address - Phone:207-798-6921
Practice Address - Fax:207-798-6829
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68678OtherBLUE CROSS BLUE SHIELD
MA0713279Medicaid
MA000095502Medicare PIN