Provider Demographics
NPI:1386992683
Name:LOPEZ, KIMBERLEY MARIE (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:MARIE
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 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-695-2682
Mailing Address - Fax:210-598-0432
Practice Address - Street 1:8335 AGORA PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1383
Practice Address - Country:US
Practice Address - Phone:210-658-8483
Practice Address - Fax:210-658-0828
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist