Provider Demographics
NPI:1528041910
Name:GULLETT, ADAM NEIL (MPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:NEIL
Last Name:GULLETT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-3622
Mailing Address - Country:US
Mailing Address - Phone:360-807-4230
Mailing Address - Fax:
Practice Address - Street 1:2330 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-3622
Practice Address - Country:US
Practice Address - Phone:360-807-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008547225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8333346Medicaid
WA8333346Medicaid