Provider Demographics
NPI:1679720288
Name:LOPEZ, LUIS (PT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 MAIN STREET
Mailing Address - Street 2:EXCEL ORTHOPEDIC REHABILITATION
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-488-0488
Mailing Address - Fax:973-887-3654
Practice Address - Street 1:1355 15TH STREET
Practice Address - Street 2:EXCEL ORTHOPEDIC REHABILITATION
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-224-8717
Practice Address - Fax:973-887-3654
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01282600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist