Provider Demographics
NPI:1932109550
Name:HAWAKA, MICHAEL A (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:HAWAKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6135
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:12460 N RANCHO VISTOSO BLVD STE 140
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1989
Practice Address - Country:US
Practice Address - Phone:520-615-6573
Practice Address - Fax:520-575-7014
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32124225100000X
WAPT00006379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA650025868OtherRAILROAD MEDICARE
WA1932109550Medicaid
WAG8930668, G8930669Medicare PIN
WA650025868OtherRAILROAD MEDICARE