Provider Demographics
NPI:1710303078
Name:GILLICK, CASEY RAY (DPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RAY
Last Name:GILLICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ROUTE 206,
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08088
Mailing Address - Country:US
Mailing Address - Phone:609-859-2426
Mailing Address - Fax:609-859-2537
Practice Address - Street 1:1805 ROUTE 206,
Practice Address - Street 2:SUITE 3 NOVACARE REHABILITATION
Practice Address - City:SOUTHAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08088
Practice Address - Country:US
Practice Address - Phone:609-859-2426
Practice Address - Fax:609-859-2537
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01536800225100000X
PAPT023282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist