Provider Demographics
NPI:1194718577
Name:LOPEZ, DANIEL (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 OLD COURT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3430
Mailing Address - Country:US
Mailing Address - Phone:410-339-4179
Mailing Address - Fax:410-339-7534
Practice Address - Street 1:2425 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3430
Practice Address - Country:US
Practice Address - Phone:410-339-4179
Practice Address - Fax:410-339-7534
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2018-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00003222255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer