Provider Demographics
NPI:1871925719
Name:LOPEZ, REBECCA M (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:M
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-7115
Mailing Address - Country:US
Mailing Address - Phone:813-396-9078
Mailing Address - Fax:
Practice Address - Street 1:13220 USF LAUREL DRIVE, MDF 5115
Practice Address - Street 2:MDC 106
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:803-396-9078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 9502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer