Healthcare Provider Details

I. General information

NPI: 1225505894
Provider Name (Legal Business Name): HALEY TARRYN HAWES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WILSHIRE BLVD STE 105
LOS ANGELES CA
90025-1015
US

IV. Provider business mailing address

12401 WILSHIRE BLVD STE 105
LOS ANGELES CA
90025-1015
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-4100
  • Fax:
Mailing address:
  • Phone: 310-826-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number295722
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number295722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: