Healthcare Provider Details

I. General information

NPI: 1609799204
Provider Name (Legal Business Name): ROXANNE NICHOLE LOCKWOOD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 PA-739
LORDS VALLEY PA
18428
US

IV. Provider business mailing address

1043 BEAR DR
NEWFOUNDLAND PA
18445-7712
US

V. Phone/Fax

Practice location:
  • Phone: 570-775-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI006004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: