Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 011349 | NY |
NPI | 1003358995 |
---|---|
Provider Name | Steffanny Lopez |
First Address | Astoria, NY 11103-3332 |
Second Address | Astoria, NY 11102-2660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 04/12/2017 |