Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | P31067 | FL |
NPI | 1104475045 |
---|---|
Provider Name | Kelly Hawkins |
First Address | Gainesville, FL 32605-1709 |
Second Address | Gainesville, FL 32608-1135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |