Individual
AXEL LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14110 SIX MILE CYPRESS PKWY, FORT MYERS, FL 33912-4314
(570) 801-0492
Mailing address
8165 PACIFIC BEACH DR, FORT MYERS, FL 33966-7955
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4133
FL
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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