Healthcare Provider Details

I. General information

NPI: 1265602809
Provider Name (Legal Business Name): RULIN J. HAWKS, PT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S 10TH AVE
CALDWELL ID
83605-4841
US

IV. Provider business mailing address

1902 S 10TH AVE
CALDWELL ID
83605-4841
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT1122
License Number StateID

VIII. Authorized Official

Name: MR. RULIN J. HAWKS
Title or Position: OWNER
Credential: P.T.
Phone: 208-453-9111