Healthcare Provider Details

I. General information

NPI: 1578120531
Provider Name (Legal Business Name): RECOVER PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 LOCUST ST N BLDG 400-101
TWIN FALLS ID
83301-4162
US

IV. Provider business mailing address

1502 LOCUST ST N BLDG 400-101
TWIN FALLS ID
83301-4162
US

V. Phone/Fax

Practice location:
  • Phone: 208-969-9956
  • Fax: 208-957-5334
Mailing address:
  • Phone: 208-969-9956
  • Fax: 208-957-5334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAINE ERICKSON HAWKES
Title or Position: OWNER
Credential: PT, DPT
Phone: 208-969-9956