Provider Demographics
NPI:1699126466
Name:LOPEZ, ROBERT EDWARD (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 RUTH DR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-3619
Mailing Address - Country:US
Mailing Address - Phone:915-252-3216
Mailing Address - Fax:
Practice Address - Street 1:1740 RUTH DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-3619
Practice Address - Country:US
Practice Address - Phone:915-252-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer