1689630220 NPI number — DR. DAWN THERESA GULICK PHD, PT, ATC

Table of content: DR. DAWN THERESA GULICK PHD, PT, ATC (NPI 1689630220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689630220 NPI number — DR. DAWN THERESA GULICK PHD, PT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GULICK
Provider First Name:
DAWN
Provider Middle Name:
THERESA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, PT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689630220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
64 BETHEL CHURCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19475-9641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-570-7153
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE UNIVERSITY PLACE; 126 COTTEE HALL
Provider Second Line Business Practice Location Address:
WIDENER UNIVERSITY
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-499-1287
Provider Business Practice Location Address Fax Number:
610-499-1231
Provider Enumeration Date:
04/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  PT001178E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0395903000 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1045643 . This is a "KEYSTONE MERCY PROVIDER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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