Provider Demographics
NPI:1053307751
Name:HAWK, TIMOTHY J (RPT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:J
Last Name:HAWK
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 PARK BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-6927
Mailing Address - Country:US
Mailing Address - Phone:423-921-8088
Mailing Address - Fax:423-921-0046
Practice Address - Street 1:482 PARK BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-6927
Practice Address - Country:US
Practice Address - Phone:423-921-8088
Practice Address - Fax:423-921-0046
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-03-14
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
TNPT0000001848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3652202Medicare ID - Type Unspecified