MEDICARE: VISTA REHAB PARTNERS, LP

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

General Provider Information

NPI Number	:	1831435437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA REHAB PARTNERS, LP

Provider Business Mailing Address
First Line	:	5100 ELDORADO PKWY
Second Line	:	#102-20FC
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6510
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

Provider Business Practice Location Address
First Line	:	5000 WESTERN CENTER BLVD
Second Line	:	#220
City	:	HALTOM CITY
State	:	TX
Zip	:	76137-2197
Country	:	US
Telephone Number	:	817-514-0519
Fax Number	:	817-514-8861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CRAIG RETTKE
Credential	:	PT
Telephone Number	:	972-529-3691

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	05/19/2022

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