Provider Demographics
NPI:1447076328
Name:SPRING, GRACELYN FAYE
Entity type:Individual
Prefix:
First Name:GRACELYN
Middle Name:FAYE
Last Name:SPRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 W WASHINGTON ST STE 74A
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3736
Mailing Address - Country:US
Mailing Address - Phone:254-431-5100
Mailing Address - Fax:254-459-4862
Practice Address - Street 1:2900 W WASHINGTON ST STE 74A
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3736
Practice Address - Country:US
Practice Address - Phone:254-431-5100
Practice Address - Fax:254-459-4862
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1396086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist