Individual
MR. JUAN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
10794 PINES BLVD STE 104, PEMBROKE PINES, FL 33026-3920
(954) 735-3535
Mailing address
4934 NW 55TH ST, TAMARAC, FL 33319-3256
(954) 682-7748
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA27791
FL
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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