Provider Demographics
NPI:1659167609
Name:DEDRICK, GREG (PT, SCD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:DEDRICK
Suffix:
Gender:
Credentials:PT, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 BUSHLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1163
Mailing Address - Country:US
Mailing Address - Phone:405-343-0777
Mailing Address - Fax:
Practice Address - Street 1:7710 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-8366
Practice Address - Country:US
Practice Address - Phone:806-355-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist