Provider Demographics
NPI:1952985434
Name:HAWKINS, ERIC D (LMT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 DIANA CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-8122
Mailing Address - Country:US
Mailing Address - Phone:154-162-1433
Mailing Address - Fax:
Practice Address - Street 1:1600 SKY PARK DR STE 209
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5889
Practice Address - Country:US
Practice Address - Phone:541-621-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist