Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Autumn Grove

Individual provider Orthopedic Physical Therapist · NPI 1033596747

Autumn Grove is a Physical Therapist in Private Practice in Hayden, Idaho. Qualified in 2012, 14 years ago. Practices with Lake City Physical Therapy P A, a 13-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Colorado and Idaho.

Years since qualifying
14
Licensed in
CO, ID
In the registry since
2015
Specialties on file
2

Practice location Address checks out

8238 N Government Way
Hayden, ID 83835-5034
Phone: (208) 762-2100
Fax: (208) 762-2101
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 11185 W. 6th Avenue, Lakewood, CO 80215 — (303) 239-6060

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT-5390 (ID)
Orthopedic Physical Therapist Taxonomy 2251X0800X · Licence PTL. 0013479 (CO)

Record details

NPI number1033596747
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMay 1, 2015
Last updated in NPPESAugust 1, 2024
Certification dateAugust 1, 2024
Mailing address8238 N Government Way, Hayden, ID 83835-5034

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Lake City Physical Therapy P A — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Hayden