Provider Demographics
NPI:1144749102
Name:LOPEZ, RHEA JANE A
Entity type:Individual
Prefix:
First Name:RHEA JANE
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CANNON ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3263
Mailing Address - Country:US
Mailing Address - Phone:718-594-7406
Mailing Address - Fax:
Practice Address - Street 1:140 MAIN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3018
Practice Address - Country:US
Practice Address - Phone:718-594-7406
Practice Address - Fax:718-594-7406
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist