Individual provider Active NPI

Leonardo L Lopez

  • Physical Therapist
  • Wildwood, FL
National Provider Identifier
1174490478
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4603 Issued in FL
Practice address
3990 E Sr 44 Ste 201
Wildwood, FL 34785-7482
Phone
(352) 330-1011
Fax
(352) 330-0208
NPI assigned
Oct 21, 2025
Last updated
Oct 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4603 FL Primary

Addresses

Primary practice location

3990 E Sr 44 Ste 201
Wildwood, FL 34785-7482

Mailing address

2922 SE 24TH Ave
Ocala, FL 34471-6196

Other practice location 1

12155 County Road 103 Ste 3
Oxford, FL 34484-2951
Phone (352) 679-0914

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251201003591 FL Practitioner - Physical Therapist in Private Practice 9739672577 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Compass DPT, LLCGroup PAC ID 0244649424, 2 clinicians

Practice addresses (Care Compare)

3990 E Sr
44 Suite 201
Wildwood, FL 34785-7482
Phone (352) 330-1011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT4603FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Compass DPT, LLC Physical Therapist CurrentSince Oct 20, 2025 Accepting new patients

Locations

12155 County Road 103
Ste 3
Oxford, FL 34484
Phone (352) 679-0914

3990 E State Road 44
Ste 201
Wildwood, FL 34785
Phone (352) 205-5195

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1761004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1174490478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2922 SE 24TH AVE",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344716196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 E SR 44 STE 201",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347857482",
            "telephone_number": "352-330-1011",
            "fax_number": "352-330-0208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12155 County Road 103 Ste 3",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "FL",
            "postal_code": "344842951",
            "country_code": "US",
            "telephone_number": "352-679-0914",
            "fax_number": "352-330-0208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "LEONARDO",
        "middle_name": "L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-21",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT4603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildwood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.