Healthcare Provider Details

I. General information

NPI: 1316875917
Provider Name (Legal Business Name): ANNA L GILLIKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 17 N
NORTH MYRTLE BEACH SC
29582-2229
US

IV. Provider business mailing address

1524 BURROWIN DR
CHESAPEAKE VA
23321-1877
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax: 843-353-3461
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217748
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058083T
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: