Michael Lopes, DPT

Key facts

NPI

1962007724

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapist 225100000X

License

12951 (CT)

Practice address

2440 Gold Star Hwy
Mystic, CT 06355-1180

Phone

(860) 536-1001

NPI assigned

Dec 1, 2020

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 1, 2020.

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1962007724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 SHEPHERD DR",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028795730",
            "telephone_number": "401-617-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 GOLD STAR HWY",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551180",
            "telephone_number": "860-536-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPES",
        "first_name": "MICHAEL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "12951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

• Cathy Ann Lee, COTA
• Annaliza Gonzales Lewerk
• Life Balance Counseling CT, LLC
• Kristin J. Lincoln, M.S., LPC
• Annie Lion-Lee
• Margaret M Loughlin, LCSW
• Main Medical-Mystic, LLC
• Dawn Manferdini, PHARM.D.
• Suzanne Manzo, PT
• Kathleen Fitzgerald Maranda, MS

All providers in Mystic, CT · Physical Therapist in Connecticut