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General NPI Number Information
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NPI Number | 1407208523
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Entity Type | Organization
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Legal Business Name | VISTA PHYSICAL THERAPY-TRADITION LLP
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 5555 ARAPAHO RD
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City | DALLAS
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State | TX
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Zip | 75248-3442
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Country | US
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Telephone | 649-620-4260
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Fax | 649-620-4261
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Provider Business Mailing Address
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Address Line | 5100 ELDORADO PKWY #102-20TR
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City | MCKINNEY
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State | TX
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Zip | 75070-6510
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Country | US
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Telephone | 649-620-4260
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Fax | 649-620-4261
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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 | PT
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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 |
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License Number State |
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