Provider Demographics
NPI:1679593784
Name:LOPEZ, JEFFREY DAVID (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:LOPEZ
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 1:1483 GADSDEN HWY
Mailing Address - Street 2:STE 112
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3160
Mailing Address - Country:US
Mailing Address - Phone:205-655-9222
Mailing Address - Fax:205-655-9233
Practice Address - Street 1:1483 GADSDEN HWY
Practice Address - Street 2:STE 112
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3160
Practice Address - Country:US
Practice Address - Phone:205-655-9222
Practice Address - Fax:205-655-9233
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51530179OtherBCBS OF AL