Healthcare Provider Details

I. General information

NPI: 1326700741
Provider Name (Legal Business Name): MICHELE STUART GLADIEUX PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SHELTON MCMURPHEY BLVD STE 300
EUGENE OR
97401-8718
US

IV. Provider business mailing address

2556 NIXON ST
EUGENE OR
97403-1639
US

V. Phone/Fax

Practice location:
  • Phone: 458-210-2940
  • Fax: 541-654-4680
Mailing address:
  • Phone: 541-554-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number03449
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: