Provider Demographics
NPI:1174125264
Name:GULIK, EILEEN (DPT, E-RYT 500)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:GULIK
Suffix:
Gender:F
Credentials:DPT, E-RYT 500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 MELENDY DR APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3660
Mailing Address - Country:US
Mailing Address - Phone:847-271-3507
Mailing Address - Fax:
Practice Address - Street 1:643 BAIR ISLAND RD, ST 103
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2754
Practice Address - Country:US
Practice Address - Phone:650-346-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist