Provider Demographics
NPI:1144832684
Name:LOPEZ, MELISSA MARIE (SLPA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5695 GARDEN VIEW CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9583
Mailing Address - Country:US
Mailing Address - Phone:956-545-4914
Mailing Address - Fax:
Practice Address - Street 1:864 CENTRAL BLVD STE 3200
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8282
Practice Address - Country:US
Practice Address - Phone:956-280-5491
Practice Address - Fax:956-350-9390
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106580-3208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty