Provider Demographics
NPI:1639517741
Name:OCKERT, LYDIA (DPT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:OCKERT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11169 E I25 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-5276
Mailing Address - Country:US
Mailing Address - Phone:720-378-6670
Mailing Address - Fax:303-557-9701
Practice Address - Street 1:11169 E I25 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-5276
Practice Address - Country:US
Practice Address - Phone:720-378-6670
Practice Address - Fax:303-557-9701
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207977225100000X
COPTL.0012941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist