Provider Demographics
NPI:1689924102
Name:LOCKWOOD, EDWARD A (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:DPT
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 322
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-0003
Mailing Address - Country:US
Mailing Address - Phone:617-623-6300
Mailing Address - Fax:617-623-6303
Practice Address - Street 1:259 ELM ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2950
Practice Address - Country:US
Practice Address - Phone:617-623-6300
Practice Address - Fax:617-623-6303
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist