Provider Demographics
NPI:1033341920
Name:HAWKS, JENNIFER ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:HAWKS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HAWKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:428 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-9519
Mailing Address - Country:US
Mailing Address - Phone:541-784-7771
Mailing Address - Fax:541-672-1466
Practice Address - Street 1:1032 SE LANE AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3956
Practice Address - Country:US
Practice Address - Phone:541-784-7771
Practice Address - Fax:205-905-6010
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13630225700000X
OR3533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1396130894OtherGROUP NPI