Provider Demographics
NPI:1972095966
Name:HAWKINS, RICHARD GORDON (PT, DPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:GORDON
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 W I 35 FRONTAGE RD STE 132
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-7375
Mailing Address - Country:US
Mailing Address - Phone:405-227-9667
Mailing Address - Fax:405-227-9658
Practice Address - Street 1:941 W I 35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034
Practice Address - Country:US
Practice Address - Phone:405-227-9667
Practice Address - Fax:405-227-9658
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist