Provider Demographics
NPI:1548404536
Name:MIKULIK, TAMRA (PT)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:
Last Name:MIKULIK
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 1:115 MEDICAL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3105
Mailing Address - Country:US
Mailing Address - Phone:361-575-2882
Mailing Address - Fax:361-574-9710
Practice Address - Street 1:115 MEDICAL DR STE 105
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3105
Practice Address - Country:US
Practice Address - Phone:361-575-2882
Practice Address - Fax:361-574-9710
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1062776OtherSTATE LICENSE