Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6472 | FL |
NPI | 1003163957 |
---|---|
Provider Name | Oscar Vincent Lopez |
First Address | Jacksonville, FL 32216-4252 |
Second Address | Hudson, FL 34667-7103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 10/08/2012 |