Provider Demographics
NPI:1841456928
Name:HAWKINS, PHILLICIA L (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PHILLICIA
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:PHILLICIA
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1337 E STATE HIGHWAY 152
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-5101
Mailing Address - Country:US
Mailing Address - Phone:405-745-4786
Mailing Address - Fax:405-745-4837
Practice Address - Street 1:1337 E STATE HIGHWAY 152
Practice Address - Street 2:SUITE 111
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-5101
Practice Address - Country:US
Practice Address - Phone:405-745-4786
Practice Address - Fax:405-745-4837
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$OtherTRICARE