Provider Demographics
NPI:1437455540
Name:LOPEZ, JOSEPH RALPH (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RALPH
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5714 S RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2134
Mailing Address - Country:US
Mailing Address - Phone:773-510-0739
Mailing Address - Fax:872-207-5023
Practice Address - Street 1:5714 S RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2134
Practice Address - Country:US
Practice Address - Phone:773-510-0739
Practice Address - Fax:872-207-5023
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070012206225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist