NPI 1891221958

Anthony Lopez, ATC

Practitioner Prevention Professional Crestwood, IL

Practice location

Address: 14011 Kenton Ave, Crestwood, IL 60445-2252
Phone: (219) 794-4653
Mailing address: 5750 Abbey Dr APT 2c, Lisle, IL 60532-2582

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 2000026450 (IL)

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Registry record

NPI: 1891221958
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 May 2017
Record last updated: 11 May 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.