Provider Demographics
NPI:1528383569
Name:LOCKETT, YOVA S (LMT)
Entity Type:Individual
Prefix:
First Name:YOVA
Middle Name:S
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KINDRED
Other - Middle Name:SPIRITS
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 450312
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-0312
Mailing Address - Country:US
Mailing Address - Phone:469-441-1712
Mailing Address - Fax:
Practice Address - Street 1:13339 N CENTRAL EXPY
Practice Address - Street 2:103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1125
Practice Address - Country:US
Practice Address - Phone:469-441-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist