Provider Demographics
NPI:1487412953
Name:HAWKINS, CAMRYN JADE (PTA)
Entity type:Individual
Prefix:MS
First Name:CAMRYN
Middle Name:JADE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 N BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-4227
Mailing Address - Country:US
Mailing Address - Phone:803-367-3868
Mailing Address - Fax:
Practice Address - Street 1:760 BARNES BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5314
Practice Address - Country:US
Practice Address - Phone:321-327-8509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32120225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant