Provider Demographics
NPI:1760616668
Name:LOPEZ, MA. CORINNE DERILO (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MA. CORINNE
Middle Name:DERILO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4313
Mailing Address - Country:US
Mailing Address - Phone:215-301-0223
Mailing Address - Fax:
Practice Address - Street 1:800 BIRCH CT
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-4313
Practice Address - Country:US
Practice Address - Phone:215-301-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018661225100000X, 2251G0304X
NY028552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics