Provider Demographics
NPI:1063480903
Name:LOCKE, BRIAN HOWARD (DPT, AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HOWARD
Last Name:LOCKE
Suffix:
Gender:M
Credentials:DPT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 N ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WEIDMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9263
Mailing Address - Country:US
Mailing Address - Phone:989-621-8673
Mailing Address - Fax:
Practice Address - Street 1:4851 E PICKARD ST STE 2600
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2042
Practice Address - Country:US
Practice Address - Phone:989-775-1657
Practice Address - Fax:989-775-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI5501017207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer