Provider Demographics
NPI:1205053261
Name:HAWKER, SCOTT GLENN (CMT, MMT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:GLENN
Last Name:HAWKER
Suffix:
Gender:M
Credentials:CMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 W 250 S
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-6061
Mailing Address - Country:US
Mailing Address - Phone:208-684-3112
Mailing Address - Fax:
Practice Address - Street 1:285 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1751
Practice Address - Country:US
Practice Address - Phone:208-785-0123
Practice Address - Fax:208-782-1885
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist