Individual ProviderIvelisse Socorro LopezPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address3901 University Blvd S, Jacksonville, FL 32216-4312(904) 858-7200(904) 982-5007PECOS EnrollmentBased on the most recent information from CMS, provider Ivelisse Socorro Lopez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1013055979Provider TypeIndividualFull NameLopez, Ivelisse SocorroCredentialP.T.GenderFemaleSole ProprietorNoEnumeration Date2/2/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address3901 University Blvd S, Jacksonville, FL 32216-4312Phone(904) 858-7200FaxUnlisted FaxMailing LocationMailing Address12979 Fringetree Dr W, Jacksonville, FL 32246-1152Phone(904) 982-5007FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense3961Florida