Provider Demographics
NPI:1326523911
Name:LOPEZ, DARLENE JANETTE GONZALES (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:JANETTE GONZALES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10329 BEVERLY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2214
Mailing Address - Country:US
Mailing Address - Phone:361-510-7655
Mailing Address - Fax:
Practice Address - Street 1:606 COYOTE TRL
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4004
Practice Address - Country:US
Practice Address - Phone:361-664-5479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049583225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant