Provider Demographics
NPI:1861568149
Name:GRANT, WENDY L (PT, DPT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:GRANT
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 1:8500 W QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1152
Mailing Address - Country:US
Mailing Address - Phone:714-300-9006
Mailing Address - Fax:
Practice Address - Street 1:8500 W QUINCY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:714-300-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT-26597225100000X
COPTL.0013022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist