Healthcare Provider Details

I. General information

NPI: 1659288306
Provider Name (Legal Business Name): JACLYN GRACE ZEGUB DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACLYN GRACE BEETER

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 4550
DENVER CO
80218-1254
US

IV. Provider business mailing address

1601 E 19TH AVE STE 4550
DENVER CO
80218-1254
US

V. Phone/Fax

Practice location:
  • Phone: 303-830-0018
  • Fax: 303-830-3957
Mailing address:
  • Phone: 303-830-0018
  • Fax: 303-830-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21540
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: