MEDICARE: MEDELLA PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1215561709	OTHER	TX	NPPES

General Provider Information

NPI Number	:	1710751185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDELLA PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2122 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4833
Country	:	US
Telephone Number	:	817-228-8322
Fax Number	:	817-286-4255

Provider Business Practice Location Address
First Line	:	2110 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4833
Country	:	US
Telephone Number	:	817-697-7982
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	SARAH KING
Credential	:
Telephone Number	:	817-228-8322

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “MEDELLA PHYSICAL THERAPY ” Practice Location

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