Provider Demographics
NPI:1134446115
Name:LOCKHART, LISA EVELYN
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:EVELYN
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15156 SHAW RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5531
Mailing Address - Country:US
Mailing Address - Phone:813-340-1360
Mailing Address - Fax:813-259-9581
Practice Address - Street 1:1802 N ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-4306
Practice Address - Country:US
Practice Address - Phone:813-340-1360
Practice Address - Fax:813-259-9581
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist