Provider Demographics
NPI:1164955712
Name:HAWKINS, SALLY M (DPT)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:M
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 EAGLE ROCK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3167
Mailing Address - Country:US
Mailing Address - Phone:973-887-9000
Mailing Address - Fax:973-887-3816
Practice Address - Street 1:70 HUDSON ST STE 2A
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030
Practice Address - Country:US
Practice Address - Phone:201-533-8111
Practice Address - Fax:201-533-8110
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023303225100000X
NJ40QA01891400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist