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Organization
SPORTSCARE & REHABILITATION
Active
Organization
SPORTSCARE & REHABILITATION
Active
Other names
Vista Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG RETTKE (PRESIDENT)
(972) 529-3691
Entity
Organization
Contact information
Practice address
6105 WINDCOM CT, SUITE 300, PLANO, TX 75093-7889
(972) 781-1111
(972) 781-1101
Mailing address
5100 W ELDORADO PKWY, #102-20SCR, MCKINNEY, TX 75070-6309
(972) 781-1111
(972) 781-1101
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
635850001
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0034EL
BCBS
TX
Enumeration date
10/04/2005
Last updated
04/14/2022
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