Provider Demographics
NPI:1881824902
Name:JORY, GRACE ELAINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELAINE
Last Name:JORY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 NEZ PERCE DR
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-4613
Mailing Address - Country:US
Mailing Address - Phone:303-957-6131
Mailing Address - Fax:
Practice Address - Street 1:240 W BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4702
Practice Address - Country:US
Practice Address - Phone:303-957-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87852071Medicaid