Provider Demographics
NPI:1750009080
Name:LOPEZ, MATTHEW AURELIO (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AURELIO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14019 SUNNY GLN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1553
Mailing Address - Country:US
Mailing Address - Phone:210-954-5609
Mailing Address - Fax:
Practice Address - Street 1:1711 FRATE BARKER RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3600
Practice Address - Country:US
Practice Address - Phone:210-954-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist