Provider Demographics
NPI:1699973867
Name:LOPEZ, BEATRIZ GEORGINA (PT)
Entity type:Individual
Prefix:MR
First Name:BEATRIZ
Middle Name:GEORGINA
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 1:1100 WREN AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3857
Mailing Address - Country:US
Mailing Address - Phone:786-322-8350
Mailing Address - Fax:305-882-0838
Practice Address - Street 1:1100 WREN AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-3857
Practice Address - Country:US
Practice Address - Phone:786-322-8350
Practice Address - Fax:305-882-0838
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL193532251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886467500Medicaid
FL886467500Medicaid