Provider Demographics
NPI:1255315610
Name:KHAN HAWKINS, AYESHA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:AYESHA
Middle Name:
Last Name:KHAN HAWKINS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MS
Other - First Name:AYESHA
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:210 CRESCENT GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4016
Mailing Address - Country:US
Mailing Address - Phone:626-606-3262
Mailing Address - Fax:
Practice Address - Street 1:210 CRESCENT GLEN DR
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4016
Practice Address - Country:US
Practice Address - Phone:626-606-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34066225100000X
NY023585-1225100000X
NJ40QA00989400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT34066OtherPT LICENSE
CAFI765AMedicare UPIN