Provider Demographics
NPI:1558550616
Name:LOPEZ, ROBERTO (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:LOPEZ
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 1:520 NE 20TH ST APT 404
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2151
Mailing Address - Country:US
Mailing Address - Phone:954-591-5557
Mailing Address - Fax:954-678-9116
Practice Address - Street 1:747 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4055
Practice Address - Country:US
Practice Address - Phone:954-316-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist