Provider Demographics
NPI:1710759089
Name:SESE, ELY ROSE LOPEZ (DPT)
Entity Type:Individual
Prefix:
First Name:ELY ROSE
Middle Name:LOPEZ
Last Name:SESE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3426
Mailing Address - Country:US
Mailing Address - Phone:925-708-7966
Mailing Address - Fax:
Practice Address - Street 1:2047 SHERMAN DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3426
Practice Address - Country:US
Practice Address - Phone:925-708-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist