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Individual

JUSTEN JOSEPH LOPEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC, LAT, PES, GTS

Contact information

Practice address
10 GLENVILLE ST, GREENWICH, CT 06831-3680
(518) 258-9828
Mailing address
10 GLENVILLE ST, GREENWICH, CT 06831-3680
(518) 258-9828

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1602
CT
2255A2300X
Athletic Trainer
AL 3159
FL
246Z00000X
Other Specialist/Technologist
002612
NY

Other

Enumeration date
11/03/2012
Last updated
02/16/2023
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