Provider Demographics
NPI:1700190824
Name:LOCKWOOD, SARA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4617 W 20TH ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3207
Mailing Address - Country:US
Mailing Address - Phone:970-352-9022
Mailing Address - Fax:970-352-9048
Practice Address - Street 1:4617 W 20TH ST STE 2A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3207
Practice Address - Country:US
Practice Address - Phone:970-352-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8976225100000X
CO00128442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist