Individual provider Active NPI

Gabriel Lopez, PTA

  • Physical Therapy Assistant
  • Lady Lake, FL
National Provider Identifier
1104723238
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA32478 Issued in FL
Practice address
201 W Guava St Ste 206
Lady Lake, FL 32159-1702
Phone
(352) 430-0473
NPI assigned
Oct 22, 2026
Last updated
Oct 22, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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 PTA32478 FL Primary

Addresses

Primary practice location

201 W Guava St Ste 206
Lady Lake, FL 32159-1702

Mailing address

201 W Guava St Ste 206
Lady Lake, FL 32159-1702
Phone (352) 205-9897

Medicare participation

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

NPI Registry JSON

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

{
    "created_epoch": "1792627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792627200000",
    "number": "1104723238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W GUAVA ST STE 206",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321591702",
            "telephone_number": "352-205-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W GUAVA ST STE 206",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321591702",
            "telephone_number": "352-430-0473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "GABRIEL",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-10-22",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA32478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lady Lake, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.