Provider Demographics
NPI:1063910032
Name:SALIK, KATHLEEN ROSE (PT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ROSE
Last Name:SALIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7156 W SURREY AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6003
Mailing Address - Country:US
Mailing Address - Phone:602-478-4119
Mailing Address - Fax:
Practice Address - Street 1:5605 W EUGIE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1272
Practice Address - Country:US
Practice Address - Phone:160-286-5583
Practice Address - Fax:602-865-5830
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ001551225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty