Provider Demographics
NPI:1295786127
Name:HAWKINS, CRAIG D (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:HAWKINS
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 1:4025 CHERRY AVE NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4859
Mailing Address - Country:US
Mailing Address - Phone:503-390-9009
Mailing Address - Fax:503-304-2226
Practice Address - Street 1:4025 CHERRY AVE NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4859
Practice Address - Country:US
Practice Address - Phone:503-390-9009
Practice Address - Fax:503-304-2226
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist