Provider Demographics
NPI:1457656795
Name:LOPEZ, TEANNE NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:TEANNE
Middle Name:NICOLE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3719
Mailing Address - Country:US
Mailing Address - Phone:954-252-8900
Mailing Address - Fax:954-252-8980
Practice Address - Street 1:8612 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3719
Practice Address - Country:US
Practice Address - Phone:954-252-8900
Practice Address - Fax:954-252-8980
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40419225100000X
TX1202823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist