Basic Information
| Provider Information | |||||||||
| NPI: | 1386842045 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAKES | ||||||||
| FirstName: | T | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 664 S MARTINIQUE CT | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852337105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025776500 | ||||||||
| FaxNumber: | 4806350050 | ||||||||
| Practice Location | |||||||||
| Address1: | 7540 N 19TH AVE | ||||||||
| Address2: | #200 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
| FaxNumber: | 8885432289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3789 | AZ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.