Provider Demographics
NPI:1306186515
Name:LOCKWOOD, TINA TOSHIYE (PT)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:TOSHIYE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 W 184TH PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4814
Mailing Address - Country:US
Mailing Address - Phone:310-538-1204
Mailing Address - Fax:310-538-1204
Practice Address - Street 1:3806 W 184TH PL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-4814
Practice Address - Country:US
Practice Address - Phone:310-538-1204
Practice Address - Fax:310-538-1204
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist