Provider Demographics
NPI:1497491484
Name:LEGER, GRACE (LMT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:LEGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 MADISON AVE APT M109
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2031
Mailing Address - Country:US
Mailing Address - Phone:612-804-3717
Mailing Address - Fax:
Practice Address - Street 1:3009 MADISON AVE APT M109
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2031
Practice Address - Country:US
Practice Address - Phone:612-804-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist