Provider Demographics
NPI:1205814423
Name:HAWK, TRACEY E (MPT)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:E
Last Name:HAWK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4098
Mailing Address - Country:US
Mailing Address - Phone:253-833-7750
Mailing Address - Fax:253-887-9804
Practice Address - Street 1:122 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4098
Practice Address - Country:US
Practice Address - Phone:253-833-7750
Practice Address - Fax:253-887-9804
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000085742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA153593OtherLABOR & INDUSTRIES
WA2253HAOtherREGENCE
WAAB24641Medicare ID - Type Unspecified
WA153593OtherLABOR & INDUSTRIES