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Individual
MRS. HOLLY K GULLICKSON
Active
Individual
MRS. HOLLY K GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4039
OR
225100000X
Physical Therapist
PT00007726
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500652195
—
OR
05
—
8334831
—
WA
01
—
P01398074
RR MEDICARE PTAN
OR
01
—
P01452484
RR MEDICARE PTAN
OR
Enumeration date
12/02/2005
Last updated
01/28/2021
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