1265602809 NPI number — RULIN J. HAWKS, PT, PLLC

Table of content: (NPI 1265602809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265602809 NPI number — RULIN J. HAWKS, PT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RULIN J. HAWKS, PT, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALDWELL PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265602809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1902 S 10TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALDWELL
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83605-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-453-9111
Provider Business Mailing Address Fax Number:
208-453-9115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 S 10TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83605-4841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-453-9111
Provider Business Practice Location Address Fax Number:
208-453-9115
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKS
Authorized Official First Name:
RULIN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-453-9111

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT1122 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912116682 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: TA179 . This is a "BCBS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 1008987 . This is a "STATE INSURANCE FUND" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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