Provider Demographics
NPI:1407942089
Name:HAWKINS, MARY ALICE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 ARBOR CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039
Mailing Address - Country:US
Mailing Address - Phone:817-229-7355
Mailing Address - Fax:
Practice Address - Street 1:1100 BRIDGEWOOD DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112
Practice Address - Country:US
Practice Address - Phone:817-457-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist