MEDICARE: SPORTSCARE & REHABILITATION

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	635850001	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0034EL	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1326035346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTSCARE & REHABILITATION

Provider Business Mailing Address
First Line	:	5100 W ELDORADO PKWY
Second Line	:	#102-20SCR
City	:	MCKINNEY
State	:	TX
Zip	:	75070-6309
Country	:	US
Telephone Number	:	972-781-1111
Fax Number	:	972-781-1101

Provider Business Practice Location Address
First Line	:	6105 WINDCOM CT
Second Line	:	SUITE 300
City	:	PLANO
State	:	TX
Zip	:	75093-7889
Country	:	US
Telephone Number	:	972-781-1111
Fax Number	:	972-781-1101

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	04/14/2022

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Directions to “SPORTSCARE & REHABILITATION ” Practice Location

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