Provider Demographics
NPI:1134973720
Name:LOCKHART-DIAZ, JAELYN
Entity type:Individual
Prefix:
First Name:JAELYN
Middle Name:
Last Name:LOCKHART-DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C7 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3041
Mailing Address - Country:US
Mailing Address - Phone:610-743-0367
Mailing Address - Fax:
Practice Address - Street 1:C7 ALPINE CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3041
Practice Address - Country:US
Practice Address - Phone:610-743-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer