Provider Demographics
NPI:1265525984
Name:LOCKETTE, GINGER D (PT)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:D
Last Name:LOCKETTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481-C KAWAILOA ROAD
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734
Mailing Address - Country:US
Mailing Address - Phone:808-261-1514
Mailing Address - Fax:
Practice Address - Street 1:354 ULUNIU STREET
Practice Address - Street 2:SUITE 404
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-262-1118
Practice Address - Fax:808-262-0045
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT1261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI49959203Medicaid
HI23071-4OtherTRICARE HNL
HI49959201Medicaid
HI5532318OtherUHA 99-033202002
HI201711OtherHMA
HIB0230710OtherKAI HMSA PPO/HMO/QST/65C
HIB0230710OtherTRICARE KAI
HI23071-4OtherHNL HMSA PPO/HMO/QST/65C
HI49959200OtherALOHA CARE
HI99-0332020OtherHMAA
HI49959201Medicaid