Provider Demographics
NPI:1417759408
Name:MIDDLETON, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 QUARRY HILL RD APT 47
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6149
Mailing Address - Country:US
Mailing Address - Phone:989-488-0710
Mailing Address - Fax:
Practice Address - Street 1:10 RHODES AVE
Practice Address - Street 2:
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6987
Practice Address - Country:US
Practice Address - Phone:401-767-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist