Provider Demographics
NPI:1619937125
Name:LOCKHART, AMBER DAWN (ATC)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:DAWN
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PIONEER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMODORE
Mailing Address - State:PA
Mailing Address - Zip Code:15729-8631
Mailing Address - Country:US
Mailing Address - Phone:724-422-4866
Mailing Address - Fax:
Practice Address - Street 1:119 PROFESSIONAL CTR
Practice Address - Street 2:SUITE 312
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-349-6214
Practice Address - Fax:724-349-0580
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer