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General NPI Number Information
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NPI Number | 1255072195
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Entity Type | Individual
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Provider Name | BENJAMIN JAMES LOCKHART DPT
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Gender | Male
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 4410 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563-8130
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Country | US
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Telephone | 850-749-5215
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Fax |
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Provider Business Mailing Address
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Address Line | 1518 BONEFISH CT
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City | GULF BREEZE
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State | FL
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Zip | 32563-8973
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Country | US
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Telephone | 850-485-4667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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