Provider Demographics
NPI:1912871088
Name:LOPEZ, JOSE GUADALUPE JR (DPT)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GUADALUPE
Last Name:LOPEZ
Suffix:JR
Gender:X
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 N FOWLER ST APT 1113
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9470
Mailing Address - Country:US
Mailing Address - Phone:575-706-6766
Mailing Address - Fax:
Practice Address - Street 1:2700 N GRIMES ST STE C
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1816
Practice Address - Country:US
Practice Address - Phone:575-392-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT-2025-0246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty