Provider Demographics
NPI:1669929055
Name:HAWKINS, TARA (RPT)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:LETSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 10TH AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5032
Mailing Address - Country:US
Mailing Address - Phone:941-722-3582
Mailing Address - Fax:941-729-8322
Practice Address - Street 1:410 10TH AVE W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5032
Practice Address - Country:US
Practice Address - Phone:941-722-3582
Practice Address - Fax:941-729-8322
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31928225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist