Provider Demographics
NPI:1962220277
Name:LOCKRIDGE, CHRISTY (LMT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-5744
Mailing Address - Country:US
Mailing Address - Phone:928-322-3645
Mailing Address - Fax:
Practice Address - Street 1:3245 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-5744
Practice Address - Country:US
Practice Address - Phone:928-322-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT27100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty