Provider Demographics
NPI:1407509649
Name:TOLLEY, DONNAGRACE R (LMT)
Entity Type:Individual
Prefix:
First Name:DONNAGRACE
Middle Name:R
Last Name:TOLLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:TOLLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6759
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-1039
Mailing Address - Country:US
Mailing Address - Phone:970-471-6898
Mailing Address - Fax:
Practice Address - Street 1:250 S FRONTAGE RD W
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-5039
Practice Address - Country:US
Practice Address - Phone:970-471-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0018185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist