Provider Demographics
NPI:1790772796
Name:ALLEN SPINE & SPORTSCARE, LLP
Entity Type:Organization
Organization Name:ALLEN SPINE & SPORTSCARE, 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:#102-20ASSC
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6309
Mailing Address - Country:US
Mailing Address - Phone:214-509-0029
Mailing Address - Fax:214-509-0070
Practice Address - Street 1:1101 RAINTREE CIR
Practice Address - Street 2:SUITE 150
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4922
Practice Address - Country:US
Practice Address - Phone:214-509-0029
Practice Address - Fax:214-509-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635850004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0023KXOtherBCBS
TX00457WMedicare PIN