Provider Demographics
NPI:1932696721
Name:LOPEZ, EUGENE (DPT)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 AIRLINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3571
Mailing Address - Country:US
Mailing Address - Phone:361-334-1033
Mailing Address - Fax:361-334-0734
Practice Address - Street 1:3201 AIRLINE RD STE E
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3571
Practice Address - Country:US
Practice Address - Phone:361-334-1033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1196318261QP2000X, 314000000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility