Provider Demographics
NPI:1871595280
Name:LOCKER, KENNETH W (ATC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:LOCKER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13519 LAMBERT LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-8099
Mailing Address - Country:US
Mailing Address - Phone:214-354-1029
Mailing Address - Fax:
Practice Address - Street 1:13519 LAMBERT LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-8099
Practice Address - Country:US
Practice Address - Phone:214-354-1029
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT02252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer