Provider Demographics
NPI:1982662292
Name:GLADUN, BORIS E (MPT)
Entity type:Individual
Prefix:
First Name:BORIS
Middle Name:E
Last Name:GLADUN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7304 LAKEWOOD DR W
Mailing Address - Street 2:STE 23
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7920
Mailing Address - Country:US
Mailing Address - Phone:253-314-5762
Mailing Address - Fax:253-314-5951
Practice Address - Street 1:7304 LAKEWOOD DR W
Practice Address - Street 2:STE 23
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7920
Practice Address - Country:US
Practice Address - Phone:206-267-7811
Practice Address - Fax:206-267-7813
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8342081Medicaid
WAAB23089Medicare ID - Type Unspecified
WA8342081Medicaid
P35447Medicare UPIN