Healthcare Provider Details

I. General information

NPI: 1720031693
Provider Name (Legal Business Name): BART RANDALL HAWKINSON PT, DPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 NE 125TH ST STE 140
SEATTLE WA
98125-4373
US

IV. Provider business mailing address

2611 NE 125TH ST STE 140
SEATTLE WA
98125-4373
US

V. Phone/Fax

Practice location:
  • Phone: 206-361-4745
  • Fax: 206-361-4877
Mailing address:
  • Phone: 206-361-4745
  • Fax: 206-361-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009758
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: