Provider Demographics
NPI:1780417147
Name:LOPEZ TAPIA, ANTONIO (DPT)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:LOPEZ TAPIA
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 1:1260 B ST STE 250
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-2971
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1260 B ST STE 250
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-2971
Practice Address - Country:US
Practice Address - Phone:510-247-9971
Practice Address - Fax:510-247-9974
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist