Deborah J Gullic, PT, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

00193 Issued in MO

Practice address

3308 W Edgewood Dr
Jefferson City, MO 65109-6891

Phone

(573) 638-3400

Fax

(573) 638-3405

NPI assigned

Jan 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1407907645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2622 MEADOW VIEW DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 W EDGEWOOD DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651096891",
            "telephone_number": "573-638-3400",
            "fax_number": "573-638-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLIC",
        "first_name": "DEBORAH",
        "middle_name": "J",
        "credential": "PT, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-15",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "002246",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "00193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Deanna Groves, MS CCC-SLP
• Talva Grundstrom, D,M,D,
• Amy Gruss
• Shelly L Gudehus, FNP
• Christina Louise Guerrero
• Victoria Gunn, M.D.
• Kristina Gupta
• Venkata Siva Reddy Guvva, BDS,PROSTHODONTICS
• Cynthia L Hackathorn, PH.D.
• Shadi Maher Haddadin, MD

• Athletic Trainer in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.