Provider Demographics
NPI:1619412053
Name:LOCKHART, JOEL THOMAS (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:THOMAS
Last Name:LOCKHART
Suffix:
Gender:M
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 1:2316 HAZARD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-6552
Mailing Address - Country:US
Mailing Address - Phone:504-273-3485
Mailing Address - Fax:
Practice Address - Street 1:9 TRADERS CIR
Practice Address - Street 2:APT 210
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4133
Practice Address - Country:US
Practice Address - Phone:504-273-3485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT80542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer