Provider Demographics
NPI:1649433327
Name:LOCKARD, SARA EVA (PT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:EVA
Last Name:LOCKARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:EVA
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-328-8833
Mailing Address - Fax:402-328-2921
Practice Address - Street 1:5401 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2150
Practice Address - Country:US
Practice Address - Phone:402-420-0020
Practice Address - Fax:402-420-0014
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2794225100000X
IA004232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025493600Medicaid
NE08775OtherBCBS
PENDINGOtherMEDICARE RAILROAD
NE10025493600Medicaid