Provider Demographics
NPI:1497706170
Name:LOPERENA, OSVALDO (DPT)
Entity Type:Individual
Prefix:DR
First Name:OSVALDO
Middle Name:
Last Name:LOPERENA
Suffix:
Gender:M
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:PO BOX 2093
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-3001
Mailing Address - Country:US
Mailing Address - Phone:787-235-3167
Mailing Address - Fax:787-826-4444
Practice Address - Street 1:CARR. # 2 KM 142.2
Practice Address - Street 2:BO. QUEBRADA LARGA
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610
Practice Address - Country:US
Practice Address - Phone:787-826-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057502Medicare ID - Type UnspecifiedPHYSICAL THERAPIST