Provider Demographics
NPI:1558234690
Name:LOPEZ, DAVID A (MUSCLE THERAPIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MUSCLE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FREEHOLD ST
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1364
Mailing Address - Country:US
Mailing Address - Phone:848-469-4661
Mailing Address - Fax:
Practice Address - Street 1:500 FREEHOLD ST
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-1364
Practice Address - Country:US
Practice Address - Phone:848-469-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTTC5722225200000X
TXMT144973225700000X
NJ18KT01528000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant