Individual provider Active NPI

Christian Adolfo Lopez, PTA

  • Physical Therapy Assistant
  • Smyrna, DE
National Provider Identifier
1093290231
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
J2-0001281 Issued in DE
Practice address
33 Deak Dr Ste 101
Smyrna, DE 19977-1268
Phone
(302) 659-5700
NPI assigned
Oct 2, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X J2-0001281 DE Primary

Addresses

Primary practice location

33 Deak Dr Ste 101
Smyrna, DE 19977-1268

Mailing address

3115 New Castle Ave TRLR 5
New Castle, DE 19720-2168
Phone (302) 464-9635

Other names 1

  • Cristian Adolfo Lopez-Magana Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
J2-0001281DEMDPhysical Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538438400000",
    "number": "1093290231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3115 NEW CASTLE AVE TRLR 5",
            "city": "NEW CASTLE",
            "state": "DE",
            "postal_code": "197202168",
            "telephone_number": "302-464-9635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 DEAK DR STE 101",
            "city": "SMYRNA",
            "state": "DE",
            "postal_code": "199771268",
            "telephone_number": "302-659-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "CHRISTIAN",
        "middle_name": "ADOLFO",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-02",
        "last_updated": "2018-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "DE",
            "license": "J2-0001281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRISTIAN",
            "last_name": "LOPEZ-MAGANA",
            "middle_name": "ADOLFO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Smyrna, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.