# MRS. HOLLY K GULLICKSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1750365755
- **Gender:** F
- **Credential:** PT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 4039 | OR | Yes |
| 225100000X | Physical Therapist | PT00007726 | WA | — |

## Other

- **Enumeration date:** 12/02/2005
- **Last updated:** 01/28/2021

## 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 |