Provider Demographics
NPI:1972834828
Name:HAWKINS, TYLER THOMAS (PTA)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:THOMAS
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3965 DORAL LN
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3867
Mailing Address - Country:US
Mailing Address - Phone:574-221-9298
Mailing Address - Fax:
Practice Address - Street 1:3965 DORAL LN.
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517
Practice Address - Country:US
Practice Address - Phone:574-221-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003745A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant