Provider Demographics
NPI:1245316900
Name:LOPEZ, CHRISTOPHER RICHARD (MS PT OCS CSCS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RICHARD
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS PT OCS CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EAST JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-746-6350
Mailing Address - Fax:516-746-6696
Practice Address - Street 1:60 EAST JERICHO TPKE
Practice Address - Street 2:PHYSICAL SOLUTIONS
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-746-6350
Practice Address - Fax:516-746-6696
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0185591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q38361Medicare ID - Type Unspecified