MEDICARE: ERIK GULLEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	294428	CA

General Provider Information

NPI Number	:	1528826161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK GULLEN PT

Provider Business Mailing Address
First Line	:	146 N GLENDORA AVE STE 101
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-5312
Country	:	US
Telephone Number	:	626-385-8844
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 N GLENDORA AVE STE 101
Second Line	:
City	:	GLENDORA
State	:	CA
Zip	:	91741-5312
Country	:	US
Telephone Number	:	626-385-8844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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