Provider Demographics
NPI:1780924209
Name:GLADU, MARIE (DPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GLADU
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 E 2900 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:MARTINTON
Mailing Address - State:IL
Mailing Address - Zip Code:60951-6036
Mailing Address - Country:US
Mailing Address - Phone:630-421-0119
Mailing Address - Fax:
Practice Address - Street 1:1768 E 2900 NORTH RD
Practice Address - Street 2:
Practice Address - City:MARTINTON
Practice Address - State:IL
Practice Address - Zip Code:60951-6036
Practice Address - Country:US
Practice Address - Phone:630-421-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2014-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018487225100000X
IL096.0027042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer