Healthcare Provider Details

I. General information

NPI: 1649433327
Provider Name (Legal Business Name): SARA EVA LOCKARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA EVA BERG PT

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 SOUTH ST
LINCOLN NE
68506-2150
US

IV. Provider business mailing address

5401 SOUTH ST
LINCOLN NE
68506-2150
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-0020
  • Fax: 402-420-0014
Mailing address:
  • Phone: 402-328-8833
  • Fax: 402-328-2921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2794
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004232
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: