Provider Demographics
NPI:1003830431
Name:GULICK, DONNA A (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:A
Last Name:GULICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-3705
Mailing Address - Fax:716-839-2347
Practice Address - Street 1:3970 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-3705
Practice Address - Fax:716-839-2347
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000603549002OtherBCBS
9390248OtherIHA
00011187501OtherUNIVERA
000603549002OtherBCBS