Provider Demographics
NPI:1427259464
Name:GLADWISH, RANDALL PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:PAUL
Last Name:GLADWISH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7727
Mailing Address - Country:US
Mailing Address - Phone:206-782-8717
Mailing Address - Fax:
Practice Address - Street 1:3800 MONTLAKE BLVD NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-3932
Practice Address - Country:US
Practice Address - Phone:206-520-5000
Practice Address - Fax:206-598-3140
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2115799Medicaid