Individual
BLAINE HAWKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
50 S HIGHWAY 93, SHOSHONE, ID 83352-5337
(801) 942-3311
(801) 495-5303
Mailing address
469 PARK TERRACE DR, TWIN FALLS, ID 83301-3211
(208) 969-9956
(208) 957-5334
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8394301-8016
UT
Other
Enumeration date
08/29/2012
Last updated
10/02/2019
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