Basic Information
| Provider Information | |||||||||
| NPI: | 1427426899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAWKINS | ||||||||
| FirstName: | JOHN | ||||||||
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| NameSuffix: | JR. | ||||||||
| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 S HOLMEN DR | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | HOLMEN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546369467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085269888 | ||||||||
| FaxNumber: | 6085269965 | ||||||||
| Practice Location | |||||||||
| Address1: | 1051 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | REEDSBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 539592321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6085247543 | ||||||||
| FaxNumber: | 6085247599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2015 | ||||||||
| LastUpdateDate: | 09/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 13216-24 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.