Provider Demographics
NPI:1407332927
Name:LOCKETT, TAYLOR VICTORIA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:VICTORIA
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 BRISTOL MNR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5651
Mailing Address - Country:US
Mailing Address - Phone:205-994-5613
Mailing Address - Fax:
Practice Address - Street 1:833 SAINT VINCENTS DR STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1609
Practice Address - Country:US
Practice Address - Phone:205-730-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer