Provider Demographics
NPI:1902367881
Name:RECOVER PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:RECOVER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:1502 LOCUST ST N
Mailing Address - Street 2:BUILDING 400 STE 101
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4162
Mailing Address - Country:US
Mailing Address - Phone:801-602-4579
Mailing Address - Fax:
Practice Address - Street 1:1502 LOCUST ST N
Practice Address - Street 2:BUILDING 400 STE 101
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4162
Practice Address - Country:US
Practice Address - Phone:801-602-4579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty