Provider Demographics
NPI:1639748270
Name:LOPEZ, VALERIE ALEXANDRA (LMT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:ALEXANDRA
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 1:3201 W PEORIA AVE STE B301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4618
Mailing Address - Country:US
Mailing Address - Phone:602-767-7788
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE B301
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4618
Practice Address - Country:US
Practice Address - Phone:602-767-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-23366225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist