MEDICARE: SARAH WEELDREYER PT, DPT, CSCS

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	1358008	TX

General Provider Information

NPI Number	:	1871241513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WEELDREYER PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	825 W ROYAL LN STE 240
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 W ROYAL LN STE 240
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-3901
Country	:	US
Telephone Number	:	972-393-8067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2022
Last Update Date	:	03/11/2022

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