Provider Demographics
NPI:1952641276
Name:LOPEZ, PEDRO MIGUEL (PTA)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:MIGUEL
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9874 SW 88TH ST
Mailing Address - Street 2:APT G 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1833
Mailing Address - Country:US
Mailing Address - Phone:305-389-3978
Mailing Address - Fax:
Practice Address - Street 1:6808 SW 81ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7708
Practice Address - Country:US
Practice Address - Phone:305-905-4188
Practice Address - Fax:305-595-6050
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 23707225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant