=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487562849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAWLEY WETZEL PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1180 ERNEST W BARRETT PKWY NW STE 100C
-----------------------------------------------------
City | KENNESAW
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30144-4534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-797-5734
-----------------------------------------------------
Fax | 770-999-2737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1180 ERNEST W BARRETT PKWY NW STE 100C
-----------------------------------------------------
City | KENNESAW
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30144-4534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-797-5734
-----------------------------------------------------
Fax | 770-999-2737
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT013081
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | PT013081
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------