Provider Demographics
NPI:1790029304
Name:LOCKLEAR, GENIA RENAE (CFTS)
Entity Type:Individual
Prefix:MRS
First Name:GENIA
Middle Name:RENAE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W 3RD ST
Mailing Address - Street 2:PO BOX 2639
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7977
Mailing Address - Country:US
Mailing Address - Phone:910-521-5600
Mailing Address - Fax:910-521-1906
Practice Address - Street 1:407 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7977
Practice Address - Country:US
Practice Address - Phone:910-521-5600
Practice Address - Fax:910-521-1906
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCFTS 7713225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter