Basic Information
| Provider Information | |||||||||
| NPI: | 1033194121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 612260 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773252776 | ||||||||
| FaxNumber: | 4089454011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1306 W AVENUE J SUITE 2 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619480186 | ||||||||
| FaxNumber: | 6619455736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 16889 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.