Provider Demographics
NPI:1073965190
Name:VISTA PHYSICAL THERAPY -TRADITION LLP
Entity Type:Organization
Organization Name:VISTA PHYSICAL THERAPY -TRADITION LLP
Other - Org Name:VISTA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-529-3691
Mailing Address - Street 1:5100 ELDORADO PKWY
Mailing Address - Street 2:102-20TR
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6510
Mailing Address - Country:US
Mailing Address - Phone:469-310-1700
Mailing Address - Fax:469-310-1701
Practice Address - Street 1:5855 MILTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-4202
Practice Address - Country:US
Practice Address - Phone:469-310-1700
Practice Address - Fax:469-310-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty