Provider Demographics
NPI:1184626558
Name:LOCKLEAR, IRIS YVONNE (LPTA)
Entity type:Individual
Prefix:MS
First Name:IRIS
Middle Name:YVONNE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 RAEFORD RD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4126
Mailing Address - Country:US
Mailing Address - Phone:910-908-2222
Mailing Address - Fax:910-829-0279
Practice Address - Street 1:4101 RAEFORD RD UNIT 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4126
Practice Address - Country:US
Practice Address - Phone:910-908-2222
Practice Address - Fax:910-829-0279
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC971225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56814492OtherTRICARE