NPIMap

Organization Active NPI

Complete Physical Therapy P.S.

  • Physical Therapy Clinic/Center
  • Lakewood, WA
National Provider Identifier
1063902385
Registry record updated May 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
COMPLETE PHYSICAL THERAPY P.S.
Practice address
7304 Lakewood Dr W Ste 23
Lakewood, WA 98499-7920
Phone
(206) 601-3305
NPI assigned
May 11, 2018
Last updated
May 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Boris E Gladun, MPTNPI 1982662292
Title
President
Phone
(206) 601-3305

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

7304 Lakewood Dr W Ste 23
Lakewood, WA 98499-7920

Mailing address

7304 Lakewood Dr W Ste 23
Lakewood, WA 98499-7920
Phone (206) 601-3305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180806002575 WA Part B Supplier - Clinic/Group Practice 7113275280 Receives reassigned benefits from 11 practitioners
Practice locations: Lakewood, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525996800000",
    "number": "1063902385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7304 LAKEWOOD DR W STE 23",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984997920",
            "telephone_number": "206-601-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7304 LAKEWOOD DR W STE 23",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984997920",
            "telephone_number": "206-601-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE PHYSICAL THERAPY P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-11",
        "last_updated": "2018-05-11",
        "status": "A",
        "authorized_official_last_name": "GLADUN",
        "authorized_official_first_name": "BORIS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-601-3305",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.