Healthcare Provider Details

I. General information

NPI: 1407332927
Provider Name (Legal Business Name): TAYLOR VICTORIA LOCKETT MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SAINT VINCENTS DR STE 100
BIRMINGHAM AL
35205-1609
US

IV. Provider business mailing address

1368 BRISTOL MNR
BIRMINGHAM AL
35242-5651
US

V. Phone/Fax

Practice location:
  • Phone: 205-730-3190
  • Fax:
Mailing address:
  • Phone: 205-994-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1805
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: