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General NPI Number Information
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NPI Number | 1760479760
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Entity Type | Organization
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Legal Business Name | SOUTHWEST SPORTS & SPINE, LLP
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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 | 11661 PRESTON RD SUITE 173
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City | DALLAS
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State | TX
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Zip | 75230-2745
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Country | US
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Telephone | 214-265-7200
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Fax | 214-265-7521
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Provider Business Mailing Address
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Address Line | 11661 PRESTON RD SUITE 173
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City | DALLAS
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State | TX
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Zip | 75230-2745
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Country | US
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Telephone | 214-265-7200
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Fax | 214-265-7521
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Authorized Official
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Title or Position | PARTNER
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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 | 635850000
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License Number State | TX
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