Provider Demographics
NPI:1033789920
Name:LOCKABY, DENNIS ROY JR
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ROY
Last Name:LOCKABY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 NEW MARKET RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9404
Mailing Address - Country:US
Mailing Address - Phone:513-535-7490
Mailing Address - Fax:
Practice Address - Street 1:1400 MALLARD COVE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3941
Practice Address - Country:US
Practice Address - Phone:513-830-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012970208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation