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NPI Code Detail

MEDICARE: GRACE NICOLE WEDDLE DPT

MEDICARE: GRACE NICOLE WEDDLE DPT
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
1225100000XPhysical Therapist1406938TX

General Provider Information

NPI Number : 1982487542
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE NICOLE WEDDLE DPT
Provider Business Mailing Address
First Line : 2427 ALLEN ST APT 127
Second Line :
City : DALLAS
State : TX
Zip : 75204-2550
Country : US
Telephone Number : 573-999-1270
Fax Number :
Provider Business Practice Location Address
First Line : 1881 SYLVAN AVE STE 150
Second Line :
City : DALLAS
State : TX
Zip : 75208-2002
Country : US
Telephone Number : 214-333-7015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 12/08/2025

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Directions to “ GRACE NICOLE WEDDLE DPT” Practice Location

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