Basic Information
| Provider Information | |||||||||
| NPI: | 1629179551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCKHART | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS,PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1417 CONSTELLATION DR | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750133467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144953812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4621 W PARK BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750932318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729851776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1127967 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.