Healthcare Provider Details

I. General information

NPI: 1063480903
Provider Name (Legal Business Name): BRIAN HOWARD LOCKE DPT, AT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 E PICKARD ST STE 2600
MT PLEASANT MI
48858-2042
US

IV. Provider business mailing address

948 N ARROWHEAD RD
WEIDMAN MI
48893-9263
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-1657
  • Fax: 989-775-1604
Mailing address:
  • Phone: 989-621-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501017207
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: