Provider Demographics
NPI:1720031693
Name:HAWKINSON, BART RANDALL (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:RANDALL
Last Name:HAWKINSON
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NE 125TH ST
Mailing Address - Street 2:STE 140
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4373
Mailing Address - Country:US
Mailing Address - Phone:206-361-4745
Mailing Address - Fax:206-361-4877
Practice Address - Street 1:2611 NE 125TH ST
Practice Address - Street 2:STE 140
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4373
Practice Address - Country:US
Practice Address - Phone:206-361-4745
Practice Address - Fax:206-361-4877
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9256HAOtherREGENCE BLUE SHIELD
WA0198205OtherWA STATE L&I
WA8428112Medicaid
WAQ48460Medicare UPIN
WA8428112Medicaid
WA9256HAOtherREGENCE BLUE SHIELD