Provider Demographics
NPI:1063477669
Name:LOCKWOOD, CAROLYN M (RPT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOLLY FARM DR
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3184
Mailing Address - Country:US
Mailing Address - Phone:508-477-4845
Mailing Address - Fax:
Practice Address - Street 1:681 FALMOUTH RD
Practice Address - Street 2:UNIT 24D
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3327
Practice Address - Country:US
Practice Address - Phone:508-477-5670
Practice Address - Fax:508-539-1790
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4167OtherMA LICENSE