Provider Demographics
NPI:1427288166
Name:LOPEZ, ANTIONETTE LYNN (PTA)
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 S FLEMING DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-7547
Mailing Address - Country:US
Mailing Address - Phone:719-248-2263
Mailing Address - Fax:
Practice Address - Street 1:752 S FLEMING DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-7547
Practice Address - Country:US
Practice Address - Phone:719-248-2263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant