Provider Demographics
NPI:1265602809
Name:RULIN J. HAWKS, PT, PLLC
Entity type:Organization
Organization Name:RULIN J. HAWKS, PT, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RULIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAWKS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-453-9111
Mailing Address - Street 1:1902 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-4841
Mailing Address - Country:US
Mailing Address - Phone:208-453-9111
Mailing Address - Fax:208-453-9115
Practice Address - Street 1:1902 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4841
Practice Address - Country:US
Practice Address - Phone:208-453-9111
Practice Address - Fax:208-453-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1122261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912116682OtherINDIVIDUAL NPI
IDTA179OtherBCBS
ID1008987OtherSTATE INSURANCE FUND
1655656Medicare UPIN