Provider Demographics
NPI:1932679438
Name:LOPES, MARCELA (LMT)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:LOPES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CENTRE ST APT A8
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2272
Mailing Address - Country:US
Mailing Address - Phone:862-571-8746
Mailing Address - Fax:
Practice Address - Street 1:550 CENTRE ST APT A8
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2272
Practice Address - Country:US
Practice Address - Phone:862-571-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01307300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist