Provider Demographics
NPI:1407328487
Name:LOPEZ, BRANDON JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
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 1:8402 CENTENNIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4792
Mailing Address - Country:US
Mailing Address - Phone:702-731-1616
Mailing Address - Fax:
Practice Address - Street 1:8402 CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4792
Practice Address - Country:US
Practice Address - Phone:702-731-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist