Provider Demographics
NPI:1700226453
Name:GRUHLKE, DORIANN LORRAINE
Entity Type:Individual
Prefix:
First Name:DORIANN
Middle Name:LORRAINE
Last Name:GRUHLKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANNI
Other - Middle Name:
Other - Last Name:GRUHLKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:121 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2510
Mailing Address - Country:US
Mailing Address - Phone:970-818-0578
Mailing Address - Fax:
Practice Address - Street 1:1337 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1115
Practice Address - Country:US
Practice Address - Phone:970-818-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
COMT.0019386225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant