Healthcare Provider Details

I. General information

NPI: 1548121486
Provider Name (Legal Business Name): GRACE MARIE VANSURKSUM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 W 6TH AVE UNIT 106B
GOLDEN CO
80401-6586
US

IV. Provider business mailing address

15000 W 6TH AVE UNIT 106B
GOLDEN CO
80401-6586
US

V. Phone/Fax

Practice location:
  • Phone: 720-541-6817
  • Fax: 720-541-6818
Mailing address:
  • Phone: 720-541-6817
  • Fax: 720-541-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number20956
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: