Provider Demographics
NPI:1790183986
Name:WESTGARD, LANIE
Entity Type:Individual
Prefix:
First Name:LANIE
Middle Name:
Last Name:WESTGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21479 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9421
Mailing Address - Country:US
Mailing Address - Phone:303-526-2574
Mailing Address - Fax:
Practice Address - Street 1:21479 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9421
Practice Address - Country:US
Practice Address - Phone:303-526-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-20
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO52002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics