Provider Demographics
NPI:1669554242
Name:LOPEZ, RONALD LYNN (MS, PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS, PT
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Other - First Name:
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Mailing Address - Street 1:1619 NW HAWTHRONE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-472-1799
Mailing Address - Fax:541-472-1699
Practice Address - Street 1:1619 NW HAWTHORNE
Practice Address - Street 2:SUITE 109
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-472-1799
Practice Address - Fax:541-472-1699
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR4012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230780Medicaid
ORR121175Medicare PIN