Provider Demographics
NPI:1497438519
Name:LOPEZ, ALEXANDRA MARET (ATC)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARET
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 US 11
Mailing Address - Street 2:UWA STATION 14
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:34570
Mailing Address - Country:US
Mailing Address - Phone:205-652-3714
Mailing Address - Fax:
Practice Address - Street 1:100 US HWY 11
Practice Address - Street 2:UWA STATION 14
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:34570
Practice Address - Country:US
Practice Address - Phone:205-652-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program