Provider Demographics
NPI:1346590643
Name:GOLIK, KELLIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:GOLIK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 N SAN ANTONIO RD STE J
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1305
Mailing Address - Country:US
Mailing Address - Phone:650-559-0011
Mailing Address - Fax:650-559-0012
Practice Address - Street 1:885 N SAN ANTONIO RD STE J
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1305
Practice Address - Country:US
Practice Address - Phone:650-559-0011
Practice Address - Fax:650-559-0012
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist