Provider Demographics
NPI:1437973559
Name:LOPEZ, MARIA CRISTINA NINA AYERDI
Entity type:Individual
Prefix:
First Name:MARIA CRISTINA NINA
Middle Name:AYERDI
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9597 ROBINSON FARM RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6880
Mailing Address - Country:US
Mailing Address - Phone:423-596-5071
Mailing Address - Fax:
Practice Address - Street 1:2626 WALKER RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1116
Practice Address - Country:US
Practice Address - Phone:423-490-1599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist