Healthcare Provider Details

I. General information

NPI: 1790997286
Provider Name (Legal Business Name): DARRELL JOSEPH LOCKET ATC, LAT, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 BONAPARTE DRIVE
JACKSONVILLE FL
32218
US

IV. Provider business mailing address

628 BONAPARTE DRIVE
JACKSONVILLE FL
32218
US

V. Phone/Fax

Practice location:
  • Phone: 904-757-7662
  • Fax:
Mailing address:
  • Phone: 904-757-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 2268
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 42799
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: