Provider Demographics
NPI:1134497969
Name:HAWKINS, MELISSA SUE (CPTA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:SUE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:SUE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-4012
Mailing Address - Country:US
Mailing Address - Phone:316-516-1140
Mailing Address - Fax:
Practice Address - Street 1:218 E PACK ST
Practice Address - Street 2:
Practice Address - City:MOUNDRIDGE
Practice Address - State:KS
Practice Address - Zip Code:67107-8815
Practice Address - Country:US
Practice Address - Phone:620-345-6391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1402230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant