Individual
LAURA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
100 SAN CARLOS RD, PUEBLO, CO 81005-2651
(719) 568-9536
Mailing address
3802 PRONGHORN LN, PUEBLO, CO 81005-3064
(719) 429-5827
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA.0012714
CO
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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