Healthcare Provider Details

I. General information

NPI: 1316370935
Provider Name (Legal Business Name): KARLI JEAN VACULIK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARLI GUTMAN PT

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SHERWOOD ST STE H
MISSOULA MT
59802-2660
US

IV. Provider business mailing address

801 SHERWOOD ST STE H
MISSOULA MT
59802-2660
US

V. Phone/Fax

Practice location:
  • Phone: 406-213-3919
  • Fax: 406-303-4368
Mailing address:
  • Phone: 406-213-3919
  • Fax: 406-303-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8500
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: