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General NPI Number Information
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NPI Number | 1992077861
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Entity Type | Individual
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Provider Name | NICOLE LYNN GILLIKIN DPT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 4084 BEDAKI AVE NE
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City | LOWELL
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State | MI
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Zip | 49331-9724
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Country | US
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Telephone | 616-691-7448
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Fax |
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Provider Business Mailing Address
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Address Line | 4084 BEDAKI AVE NE
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City | LOWELL
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State | MI
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Zip | 49331-9724
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Country | US
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Telephone | 616-691-7448
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6624
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015704
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | J1-0002759
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License Number State | DE
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