Provider Demographics
NPI:1093433385
Name:HAWKINS, ALLIE ROSE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:ROSE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MELISSA
Mailing Address - State:TX
Mailing Address - Zip Code:75454-2500
Mailing Address - Country:US
Mailing Address - Phone:951-790-6184
Mailing Address - Fax:
Practice Address - Street 1:2700 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2500
Practice Address - Country:US
Practice Address - Phone:951-790-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT7428207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty