Healthcare Provider Details

I. General information

NPI: 1639785553
Provider Name (Legal Business Name): HAWK THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MILLSTONE DR
EVANS GA
30809-5173
US

IV. Provider business mailing address

616 MILLSTONE DR
EVANS GA
30809-5173
US

V. Phone/Fax

Practice location:
  • Phone: 706-564-7796
  • Fax:
Mailing address:
  • Phone: 706-564-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS HAWK
Title or Position: AUTHORIZED OFFICAIL
Credential:
Phone: 706-564-7796