Provider Demographics
NPI:1033106984
Name:SOUTHWEST SPORTS & SPINE V, LLP
Entity Type:Organization
Organization Name:SOUTHWEST SPORTS & SPINE V, LLP
Other - Org Name:VISTA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-529-3691
Mailing Address - Street 1:5100 W ELDORADO PKWY
Mailing Address - Street 2:#102-20KT
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:214-346-9105
Mailing Address - Fax:214-346-9125
Practice Address - Street 1:3535 TRAVIS ST
Practice Address - Street 2:SUITE 160
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1448
Practice Address - Country:US
Practice Address - Phone:214-346-9105
Practice Address - Fax:214-346-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635850006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty