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Organization
SOUTHWEST SPORTS & SPINE, LLP
Active
Organization
SOUTHWEST SPORTS & SPINE, LLP
Active
Other names
Vista Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG RETTKE (PARTNER)
(972) 529-3691
Entity
Organization
Contact information
Practice address
11661 PRESTON RD, SUITE 173, DALLAS, TX 75230-2745
(214) 265-7200
(214) 265-7521
Mailing address
11661 PRESTON RD, SUITE 173, DALLAS, TX 75230-2745
(214) 265-7200
(214) 265-7521
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
635850000
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0033EL
BCBS
TX
Enumeration date
10/04/2005
Last updated
04/14/2022
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