MEDICARE: BROOKE LOCKARD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0014981	CO

General Provider Information

NPI Number	:	1114432580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE LOCKARD DPT

Provider Business Mailing Address
First Line	:	PO BOX 2228
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-2228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2228
Second Line	:
City	:	TELLURIDE
State	:	CO
Zip	:	81435-2228
Country	:	US
Telephone Number	:	970-728-8948
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “ BROOKE LOCKARD DPT” Practice Location

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