Provider Demographics
NPI:1669591210
Name:LOCKERT, JOHN ANTHONY (CO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:LOCKERT
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 APPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-7311
Mailing Address - Country:US
Mailing Address - Phone:910-793-6516
Mailing Address - Fax:
Practice Address - Street 1:4217 APPLETON WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-7311
Practice Address - Country:US
Practice Address - Phone:910-793-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO003792222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist