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JONATHON WORTH LOCKE
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1962048454
Individual Registrant: JONATHON WORTH LOCKE
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
UWA STATION 14 LIVINGSTON, AL 35470 US
Tel: 205-652-5483 Fax: --
Tel: 205-652-5483 Fax: --
Contact information for business:
1768 COUNTY ROAD 85 PRATTVILLE, AL 36067-7633 US
Tel: 334-201-4592 Fax: --
Tel: 334-201-4592 Fax: --
Registration Information:
NPI: 1962048454
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | AL |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
