Provider Demographics
NPI:1568640225
Name:LOPES, JOAO BALTAZAR (PT)
Entity Type:Individual
Prefix:MR
First Name:JOAO
Middle Name:BALTAZAR
Last Name:LOPES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BAYBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7709
Mailing Address - Country:US
Mailing Address - Phone:561-339-7667
Mailing Address - Fax:561-972-7437
Practice Address - Street 1:160 BAYBERRY CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7709
Practice Address - Country:US
Practice Address - Phone:561-339-7667
Practice Address - Fax:561-972-7437
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist