Provider Demographics
NPI:1104427103
Name:MCCORMICK, GRACE (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MCCORMICK
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 1:3605 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-6630
Mailing Address - Country:US
Mailing Address - Phone:719-265-6601
Mailing Address - Fax:719-265-6649
Practice Address - Street 1:3605 AUSTIN BLUFFS PKWY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6630
Practice Address - Country:US
Practice Address - Phone:719-265-6601
Practice Address - Fax:719-265-6649
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25278225100000X
CO18767225100000X
IL070026586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist