Provider Demographics
NPI:1437763786
Name:ANTHONY, MIKE LOPEZ (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:LOPEZ
Last Name:ANTHONY
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 1:12952 BANDERA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4733
Mailing Address - Country:US
Mailing Address - Phone:830-253-2101
Mailing Address - Fax:830-779-2056
Practice Address - Street 1:13857 US HIGHWAY 87 W STE 400
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5921
Practice Address - Country:US
Practice Address - Phone:830-253-2101
Practice Address - Fax:830-779-2056
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5777225100000X
TX1334470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist