Individual
JASON PATRICK LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC, CES
Contact information
Practice address
700 MONROE ST SW, HUNTSVILLE, AL 35801-5579
(813) 690-1290
Mailing address
132 PARKVIEW DR, MERIDIANVILLE, AL 35759-2339
(813) 690-1290
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1606
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000007080
BOC
—
Enumeration date
11/08/2021
Last updated
11/08/2021
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