Healthcare Provider Details

I. General information

NPI: 1457282907
Provider Name (Legal Business Name): GRACE CAROLYN LASOTA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ROCK POINT DR STE C
DURANGO CO
81301-7728
US

IV. Provider business mailing address

2007 CRESTVIEW DR
DURANGO CO
81301-4814
US

V. Phone/Fax

Practice location:
  • Phone: 970-247-7895
  • Fax:
Mailing address:
  • Phone: 941-565-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTPL.0000448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: