Provider Demographics
NPI:1093720906
Name:LOCKYER, ALEXIS W (PT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:W
Last Name:LOCKYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MICHELLE
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:STE 300
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2796
Practice Address - Country:US
Practice Address - Phone:864-528-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4446225100000X
TN9925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC650026189OtherMEDICARE RAILROAD NUMBER
SCC5655OtherMEDCOST NUMBER
SC943423122OtherPROVIDER NUMBER
SC7796338OtherAETNA
SC354105600OtherDEPT. OF LABOR NUMBER
SC354105600OtherDEPT. OF LABOR NUMBER