Healthcare Provider Details

I. General information

NPI: 1376450650
Provider Name (Legal Business Name): MOLLY HAWKINS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 S BROAD ST UNIT 35
PHILADELPHIA PA
19145-2343
US

IV. Provider business mailing address

2546 S 8TH ST
PHILADELPHIA PA
19148-4509
US

V. Phone/Fax

Practice location:
  • Phone: 267-996-3900
  • Fax:
Mailing address:
  • Phone: 401-275-3707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI007096
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: