Provider Demographics
NPI:1780615245
Name:HAWKINS, TIMOTHY D (PT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
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 1:1213 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3316
Mailing Address - Country:US
Mailing Address - Phone:908-222-8308
Mailing Address - Fax:
Practice Address - Street 1:16 ETHEL RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2249
Practice Address - Country:US
Practice Address - Phone:732-248-0088
Practice Address - Fax:732-248-4406
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00952900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00952900OtherPHYSICAL THERAPY LICENSE