Provider Demographics
NPI:1689630220
Name:GULICK, DAWN THERESA (PHD, PT, ATC)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:THERESA
Last Name:GULICK
Suffix:
Gender:F
Credentials:PHD, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SPRING CITY
Mailing Address - State:PA
Mailing Address - Zip Code:19475-9641
Mailing Address - Country:US
Mailing Address - Phone:610-570-7153
Mailing Address - Fax:
Practice Address - Street 1:ONE UNIVERSITY PLACE; 126 COTTEE HALL
Practice Address - Street 2:WIDENER UNIVERSITY
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-499-1287
Practice Address - Fax:610-499-1231
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001178E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0395903000OtherBLUE CROSS/BLUE SHIELD
PA1045643OtherKEYSTONE MERCY PROVIDER
PA396746Medicare ID - Type UnspecifiedAQUASPORT PT GROUP NUMBER