Provider Demographics
NPI:1487217683
Name:LOCKMAN, MIRIAM E (LMT)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:E
Last Name:LOCKMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0972
Mailing Address - Country:US
Mailing Address - Phone:406-671-7113
Mailing Address - Fax:
Practice Address - Street 1:810 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9326
Practice Address - Country:US
Practice Address - Phone:406-671-7113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist