Provider Demographics
NPI:1932534757
Name:HAWLEY, MARI C (LMT)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:C
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13710 METROPOLIS AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7144
Mailing Address - Country:US
Mailing Address - Phone:239-362-1485
Mailing Address - Fax:239-822-6609
Practice Address - Street 1:13710 METROPOLIS AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-362-1485
Practice Address - Fax:239-822-6609
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL36263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist