Provider Demographics
NPI:1992587901
Name:GILLIGAN, CHARLES U (DPT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:U
Last Name:GILLIGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 E CARRILLO RD APT 2
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2439
Mailing Address - Country:US
Mailing Address - Phone:571-329-6976
Mailing Address - Fax:
Practice Address - Street 1:1731 STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2521
Practice Address - Country:US
Practice Address - Phone:571-329-6976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT304459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist