Provider Demographics
NPI:1306962469
Name:HAWBAKER, KARYN L (DPT)
Entity type:Individual
Prefix:MRS
First Name:KARYN
Middle Name:L
Last Name:HAWBAKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 OLD GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-1297
Mailing Address - Country:US
Mailing Address - Phone:309-657-7560
Mailing Address - Fax:888-653-8027
Practice Address - Street 1:321 OLD GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-1297
Practice Address - Country:US
Practice Address - Phone:309-657-7560
Practice Address - Fax:888-653-8027
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700116632251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics