Provider Demographics
NPI:1336887009
Name:LOCKE, CONNOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:LOCKE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18324 MAFFEY DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2267
Mailing Address - Country:US
Mailing Address - Phone:510-209-9130
Mailing Address - Fax:
Practice Address - Street 1:18324 MAFFEY DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-2267
Practice Address - Country:US
Practice Address - Phone:510-209-9130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist