Provider Demographics
NPI:1811313703
Name:GAVITT, LAUREE LYN (ASSOCIATES DEGREE)
Entity type:Individual
Prefix:
First Name:LAUREE
Middle Name:LYN
Last Name:GAVITT
Suffix:
Gender:F
Credentials:ASSOCIATES DEGREE
Other - Prefix:
Other - First Name:LAUREE
Other - Middle Name:LYN
Other - Last Name:MCELRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:CO
Mailing Address - Zip Code:80107-7907
Mailing Address - Country:US
Mailing Address - Phone:303-910-9104
Mailing Address - Fax:
Practice Address - Street 1:8301 E PRENTICE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2903
Practice Address - Country:US
Practice Address - Phone:303-322-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-15
Last Update Date:2014-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012616225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant