Provider Demographics
NPI:1710862453
Name:HAWKINS, SAGE-MARIE ROSE (LMT, MLD, BCTMB)
Entity type:Individual
Prefix:
First Name:SAGE-MARIE
Middle Name:ROSE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMT, MLD, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 BRENTLEY RD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2145
Mailing Address - Country:US
Mailing Address - Phone:301-254-4631
Mailing Address - Fax:
Practice Address - Street 1:7696 SAM SNEAD HWY
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2775
Practice Address - Country:US
Practice Address - Phone:540-839-7547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2619225700000X
MDM06439225700000X
VA19012173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist