Provider Demographics
NPI:1669669388
Name:KULIKOWSKI, THERESA K (PA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:K
Last Name:KULIKOWSKI
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1134 EAST 3300 SOUTH
Mailing Address - Street 2:#313
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:719-205-2055
Mailing Address - Fax:
Practice Address - Street 1:5323 S WOODROW STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5841
Practice Address - Country:US
Practice Address - Phone:801-747-1020
Practice Address - Fax:801-747-1023
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2009-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5140165-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical