Provider Demographics
NPI:1023440492
Name:GOLIC, KATHERINE ELAINE (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELAINE
Last Name:GOLIC
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 1:13705 460TH CT SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8866
Mailing Address - Country:US
Mailing Address - Phone:425-688-5911
Mailing Address - Fax:425-688-5912
Practice Address - Street 1:1417 116TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3821
Practice Address - Country:US
Practice Address - Phone:425-688-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist