Provider Demographics
NPI:1699560425
Name:HAWKINS, AMY SUE (PTA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:HAWKINS
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:SUE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6410 STAPLE RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-8521
Mailing Address - Country:US
Mailing Address - Phone:231-750-4899
Mailing Address - Fax:
Practice Address - Street 1:18525 WOODLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8876
Practice Address - Country:US
Practice Address - Phone:616-842-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant