Provider Demographics
NPI:1770630840
Name:LOPEZ, ILEANA DEL CARMEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ILEANA
Middle Name:DEL CARMEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LLEANA
Other - Middle Name:
Other - Last Name:SILVERMAN,ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:1950 WRENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-5172
Mailing Address - Country:US
Mailing Address - Phone:407-925-5481
Mailing Address - Fax:
Practice Address - Street 1:1950 WRENFIELD LN
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-5172
Practice Address - Country:US
Practice Address - Phone:407-925-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891134700Medicaid