Provider Demographics
NPI:1962065235
Name:LOPEZ, GUILLERMO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 CALLE DENVER
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-5016
Mailing Address - Country:US
Mailing Address - Phone:787-630-4554
Mailing Address - Fax:
Practice Address - Street 1:1316 CALLE DENVER
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5016
Practice Address - Country:US
Practice Address - Phone:787-630-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist