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General NPI Number Information
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NPI Number | 1063902385
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Entity Type | Organization
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Legal Business Name | COMPLETE PHYSICAL THERAPY P.S.
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 7304 LAKEWOOD DR W STE 23
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City | LAKEWOOD
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State | WA
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Zip | 98499-7920
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Country | US
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Telephone | 206-601-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 7304 LAKEWOOD DR W STE 23
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City | LAKEWOOD
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State | WA
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Zip | 98499-7920
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Country | US
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Telephone | 206-601-3305
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BORIS E GLADUN
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Credential | MPT
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Telephone | 206-601-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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