Provider Demographics
NPI:1114776036
Name:LOPEZ GOMEZ, ANA CRISTINA (DPT, PT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:CRISTINA
Last Name:LOPEZ GOMEZ
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 S CARRIER PKWY STE 490
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-6668
Mailing Address - Country:US
Mailing Address - Phone:972-262-9972
Mailing Address - Fax:972-262-9986
Practice Address - Street 1:5833 W I 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1057
Practice Address - Country:US
Practice Address - Phone:817-561-1115
Practice Address - Fax:817-516-1104
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1397376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist