Provider Demographics
NPI:1851691893
Name:LOCKHART, LARRY JR (PERSONAL TRAINER)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LOCKHART
Suffix:JR
Gender:M
Credentials:PERSONAL TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 LANTRAC CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4006
Mailing Address - Country:US
Mailing Address - Phone:678-281-1554
Mailing Address - Fax:678-609-1484
Practice Address - Street 1:2511 LANTRAC CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4006
Practice Address - Country:US
Practice Address - Phone:678-281-1554
Practice Address - Fax:678-609-1484
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 133NN1002X, 174400000X, 225XP0019X, 390200000X, 246Z00000X, 103TE1100X
GA71212-8262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174400000XOther Service ProvidersSpecialist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports