Provider Demographics
NPI:1457668923
Name:LOPEZ, NATALIE ROSE (PT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ROSE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17969 MONTAGUE CT
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1945
Mailing Address - Country:US
Mailing Address - Phone:818-339-2306
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD
Practice Address - Street 2:560
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1571
Practice Address - Country:US
Practice Address - Phone:818-763-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist