Provider Demographics
NPI:1053836361
Name:HAWKER, AMBER VALENE (PTA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:VALENE
Last Name:HAWKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 W FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1751
Mailing Address - Country:US
Mailing Address - Phone:208-785-0123
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:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5142208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty