Individual
EDGARDO RIVERA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, CSCS
Contact information
Practice address
4301 BROADWAY, SAN ANTONIO, TX 78209-6318
(210) 829-6017
Mailing address
215 N LOOP 1604 E, SAN ANTONIO, TX 78232-1276
(787) 414-6576
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
1362473
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1362473
—
TX
Enumeration date
07/19/2022
Last updated
07/19/2022
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