Provider Demographics
NPI:1902050487
Name:LOPEZ, ROBERT C (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 FREETOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2356
Mailing Address - Country:US
Mailing Address - Phone:603-895-6860
Mailing Address - Fax:603-895-6861
Practice Address - Street 1:64 FREETOWN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2356
Practice Address - Country:US
Practice Address - Phone:603-895-6860
Practice Address - Fax:603-895-6861
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0594225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant