Provider Demographics
NPI:1679969513
Name:LOPEZ ARIAS, DANIEL (LMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LOPEZ ARIAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 W 100TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3516
Mailing Address - Country:US
Mailing Address - Phone:469-263-5996
Mailing Address - Fax:815-469-7360
Practice Address - Street 1:4048 W 100TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3516
Practice Address - Country:US
Practice Address - Phone:469-263-5996
Practice Address - Fax:815-469-7360
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227017245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist