Healthcare Provider Details

I. General information

NPI: 1912116682
Provider Name (Legal Business Name): RULIN J HAWKS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 S 10TH AVE STE 100
CALDWELL ID
83605-4880
US

IV. Provider business mailing address

1818 S 10TH AVE STE 100
CALDWELL ID
83605-4880
US

V. Phone/Fax

Practice location:
  • Phone: 208-453-9111
  • Fax: 208-453-9115
Mailing address:
  • Phone: 208-453-9111
  • Fax: 208-453-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT1122
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: