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General NPI Number Information
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NPI Number | 1588900187
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Entity Type | Organization
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Legal Business Name | VISTA REHAB PARTNERS, LP
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 5301 WILLIAM D TATE AVE
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City | GRAPEVINE
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State | TX
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Zip | 76051-7357
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Country | US
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Telephone | 817-442-5601
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Fax | 817-442-9491
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Provider Business Mailing Address
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Address Line | 5100 ELDORADO PKWY #102-20BE
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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 | 817-442-5601
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Fax | 817-442-9491
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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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