Provider Demographics
NPI:1770268476
Name:HAWKE, SHANNON KELSEY
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:KELSEY
Last Name:HAWKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 FORGE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3668
Mailing Address - Country:US
Mailing Address - Phone:610-639-8438
Mailing Address - Fax:
Practice Address - Street 1:2555 FORGE WAY
Practice Address - Street 2:
Practice Address - City:WEST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-3668
Practice Address - Country:US
Practice Address - Phone:610-639-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist