Provider Demographics
NPI:1629588702
Name:LOPEZ, LUISA (LMT)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 N ALAFAYA TRL STE 208-209
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-4351
Mailing Address - Country:US
Mailing Address - Phone:407-658-4225
Mailing Address - Fax:
Practice Address - Street 1:626 N ALAFAYA TRL STE 208-209
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4351
Practice Address - Country:US
Practice Address - Phone:407-658-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA76892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist