Provider Demographics
NPI:1326689100
Name:WATERS, GRACE MARIE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MARIE
Last Name:WATERS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16816 W 16TH PL APT 3
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2780
Mailing Address - Country:US
Mailing Address - Phone:309-732-6461
Mailing Address - Fax:
Practice Address - Street 1:1120 N LINCOLN ST STE 907
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2138
Practice Address - Country:US
Practice Address - Phone:720-583-0439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist