Provider Demographics
NPI:1578120531
Name:RECOVER PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:RECOVER PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:ERICKSON
Authorized Official - Last Name:HAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-602-4579
Mailing Address - Street 1:469 PARK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3211
Mailing Address - Country:US
Mailing Address - Phone:801-602-4579
Mailing Address - Fax:
Practice Address - Street 1:50 S HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:SHOSHONE
Practice Address - State:ID
Practice Address - Zip Code:83352-5337
Practice Address - Country:US
Practice Address - Phone:208-969-9956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty