MEDICARE: LAURA HAWKINS BABB DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5734	MS

General Provider Information

NPI Number	:	1679301691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA HAWKINS BABB DPT

Provider Business Mailing Address
First Line	:	580 FRIARS POINT RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9734
Country	:	US
Telephone Number	:	662-902-1388
Fax Number	:	866-309-6521

Provider Business Practice Location Address
First Line	:	580 FRIARS POINT RD
Second Line	:
City	:	CLARKSDALE
State	:	MS
Zip	:	38614-9734
Country	:	US
Telephone Number	:	662-902-1388
Fax Number	:	866-309-6521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	07/22/2024

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