Healthcare Provider Details

I. General information

NPI: 1053221770
Provider Name (Legal Business Name): GRACE LORDS PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 N GATEWAY DR STE 160
PROVIDENCE UT
84332-9882
US

IV. Provider business mailing address

169 N GATEWAY DR STE 160
PROVIDENCE UT
84332-9882
US

V. Phone/Fax

Practice location:
  • Phone: 435-799-3111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number143047702401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: