Provider Demographics
NPI:1710696273
Name:LOPEZ, MARTHA YANNET (RPT)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:YANNET
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4779 SABLE PINE CIR APT D2
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-2701
Mailing Address - Country:US
Mailing Address - Phone:561-797-8407
Mailing Address - Fax:
Practice Address - Street 1:2501 N AUSTRALIAN AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5638
Practice Address - Country:US
Practice Address - Phone:561-655-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist