Provider Demographics
NPI:1841801958
Name:GRANT, JAQUELINE JOAN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:JOAN
Last Name:GRANT
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8147 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-5843
Mailing Address - Country:US
Mailing Address - Phone:303-875-0780
Mailing Address - Fax:
Practice Address - Street 1:2305 PIERCE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80214-1031
Practice Address - Country:US
Practice Address - Phone:303-875-0780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer