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General NPI Number Information
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NPI Number | 1326035346
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Entity Type | Organization
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Legal Business Name | SPORTSCARE & REHABILITATION
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 6105 WINDCOM CT SUITE 300
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City | PLANO
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State | TX
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Zip | 75093-7889
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Country | US
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Telephone | 972-781-1111
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Fax | 972-781-1101
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Provider Business Mailing Address
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Address Line | 5100 W ELDORADO PKWY #102-20SCR
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City | MCKINNEY
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State | TX
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Zip | 75070-6309
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Country | US
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Telephone | 972-781-1111
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Fax | 972-781-1101
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Authorized Official
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Title or Position | PRESIDENT
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Name | CRAIG RETTKE
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Credential |
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Telephone | 972-529-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 635850001
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License Number State | TX
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