MEDICARE: MAKENNA GRACE BODETTE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	21301	CO

General Provider Information

NPI Number	:	1386576791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENNA GRACE BODETTE DPT

Provider Business Mailing Address
First Line	:	7218 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3187
Country	:	US
Telephone Number	:	719-505-7510
Fax Number	:	719-505-7229

Provider Business Practice Location Address
First Line	:	7218 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3187
Country	:	US
Telephone Number	:	719-505-7510
Fax Number	:	719-505-7229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ MAKENNA GRACE BODETTE DPT” Practice Location

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