Provider Demographics
NPI:1477516946
Name:HAWTHORNE, ZACHARY J (DPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:J
Last Name:HAWTHORNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 NE 65TH ST
Mailing Address - Street 2:# 115
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6655
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:4220 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2317
Practice Address - Country:US
Practice Address - Phone:425-258-5330
Practice Address - Fax:425-258-6118
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8905408Medicare PIN
WAG8805365Medicare PIN