Provider Demographics
NPI:1326700741
Name:GLADIEUX, MICHELE STUART (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:STUART
Last Name:GLADIEUX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 NIXON ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1639
Mailing Address - Country:US
Mailing Address - Phone:541-554-1702
Mailing Address - Fax:
Practice Address - Street 1:120 SHELTON MCMURPHEY BLVD STE 300
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8718
Practice Address - Country:US
Practice Address - Phone:458-210-2940
Practice Address - Fax:541-654-4680
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR03449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist