Provider Demographics
NPI:1831353143
Name:LOPEZ, NANCY JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEAN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22340 HARBOR RIDGE LN
Mailing Address - Street 2:#2
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2435
Mailing Address - Country:US
Mailing Address - Phone:310-320-9002
Mailing Address - Fax:
Practice Address - Street 1:1919 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5515
Practice Address - Country:US
Practice Address - Phone:310-378-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 20763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist