Provider Demographics
NPI:1962267963
Name:LOPEZ BARRIOS, MARIA BERNARDA (PTA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:BERNARDA
Last Name:LOPEZ BARRIOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5008
Mailing Address - Country:US
Mailing Address - Phone:347-757-1504
Mailing Address - Fax:
Practice Address - Street 1:10522 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5008
Practice Address - Country:US
Practice Address - Phone:347-757-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant