Provider Demographics
NPI:1275118002
Name:LOCKETT, BENJAMIN EARL (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:EARL
Last Name:LOCKETT
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7051 147TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4734
Mailing Address - Country:US
Mailing Address - Phone:612-226-0967
Mailing Address - Fax:
Practice Address - Street 1:6957 HIGHWAY 10 NW STE 102
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-6059
Practice Address - Country:US
Practice Address - Phone:612-226-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty