Provider Demographics
NPI:1659399699
Name:THERESA M LOCKE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:THERESA M LOCKE PHYSICAL THERAPY, INC
Other - Org Name:PINNACLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-736-0956
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:ANGELS CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95221-0637
Mailing Address - Country:US
Mailing Address - Phone:209-736-0956
Mailing Address - Fax:209-736-0959
Practice Address - Street 1:571 STANISLAUS AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ANGELS CAMP
Practice Address - State:CA
Practice Address - Zip Code:95222-9354
Practice Address - Country:US
Practice Address - Phone:209-736-0956
Practice Address - Fax:209-736-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT132160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6240150001Medicare NSC
CAZZZ18166ZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST