Individual
MICAELA BROOKE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5507 SW 9TH AVE # 4130, AMARILLO, TX 79106-4130
(806) 468-7611
Mailing address
6705 DIAMOND CT, AMARILLO, TX 79124-1139
(806) 570-4845
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2151672
TX
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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