Provider Demographics
NPI:1417296302
Name:LOPEZ, MARCOS FEDERICO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:FEDERICO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 LOMA DEL SUR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3597
Mailing Address - Country:US
Mailing Address - Phone:915-755-0738
Mailing Address - Fax:915-755-6941
Practice Address - Street 1:4758 LOMA DEL SUR DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-3597
Practice Address - Country:US
Practice Address - Phone:915-755-0738
Practice Address - Fax:915-755-6941
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist