Individual
SCOTT GLENN HAWKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMT, MMT
Contact information
Practice address
285 W FRANCIS ST, BLACKFOOT, ID 83221-1751
(208) 785-0123
(208) 782-1885
Mailing address
951 W 250 S, BLACKFOOT, ID 83221-6061
(208) 684-3112
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
ID
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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