Provider Demographics
NPI:1386842045
Name:HAKES, T MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:T
Middle Name:MICHAEL
Last Name:HAKES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 S MARTINIQUE CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7105
Mailing Address - Country:US
Mailing Address - Phone:602-577-6500
Mailing Address - Fax:480-635-0050
Practice Address - Street 1:7540 N 19TH AVE
Practice Address - Street 2:#200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7967
Practice Address - Country:US
Practice Address - Phone:888-873-4221
Practice Address - Fax:888-543-2289
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist