Provider Demographics
NPI:1912116682
Name:HAWKS, RULIN J (PT)
Entity Type:Individual
Prefix:MR
First Name:RULIN
Middle Name:J
Last Name:HAWKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT11222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1008987OtherSTATE INS VENDOR #
IDTA179OtherBCBS ID #
ID611699600OtherACS PROVDER #
ID804131400Medicaid
ID201338290OtherFEDERAL TAX ID NUMBER
ID611699600OtherACS PROVDER #