Provider Demographics
NPI:1386374775
Name:HAWKINS, TRISTAN MICHAEL (ATC, LAT)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:MICHAEL
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 KELLY DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-9217
Mailing Address - Country:US
Mailing Address - Phone:254-722-0559
Mailing Address - Fax:
Practice Address - Street 1:300 ROCK CHURCH HWY
Practice Address - Street 2:
Practice Address - City:TOLAR
Practice Address - State:TX
Practice Address - Zip Code:76476
Practice Address - Country:US
Practice Address - Phone:254-722-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT76042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer