Provider Demographics
NPI:1184353070
Name:MEDAUGH, GRACE LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:LAUREN
Last Name:MEDAUGH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 S PARKER RD UNIT 500
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-1270
Mailing Address - Country:US
Mailing Address - Phone:720-361-2304
Mailing Address - Fax:720-361-2639
Practice Address - Street 1:6202 S PARKER RD UNIT 500
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-1270
Practice Address - Country:US
Practice Address - Phone:720-361-2304
Practice Address - Fax:720-361-2639
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist