Provider Demographics
NPI:1487098745
Name:HAWKINS, LEA ANN (LMT)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:ANN
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 GREAT NORTHERN AVE
Mailing Address - Street 2:# 602
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1732
Mailing Address - Country:US
Mailing Address - Phone:406-880-9011
Mailing Address - Fax:
Practice Address - Street 1:2500 GREAT NORTHERN AVE
Practice Address - Street 2:# 602
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1732
Practice Address - Country:US
Practice Address - Phone:406-880-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist