Individual
MRS. HOLLY K GULLICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
915 NE 7TH ST STE 1, BEND, OR 97701-4515
(541) 728-0974
(541) 728-0159
Mailing address
915 NE 7TH ST STE 1, BEND, OR 97701-4515
(541) 728-0974
(541) 728-0159
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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