Provider Demographics
NPI:1316370935
Name:VACULIK, KARLI JEAN (DPT)
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:JEAN
Last Name:VACULIK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:
Other - Last Name:GUTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:801 SHERWOOD ST STE H
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2660
Mailing Address - Country:US
Mailing Address - Phone:406-213-3919
Mailing Address - Fax:406-303-4368
Practice Address - Street 1:801 SHERWOOD ST STE H
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2660
Practice Address - Country:US
Practice Address - Phone:406-213-3919
Practice Address - Fax:406-303-4368
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8883908Medicare UPIN