1801132410 NPI number — VISTA REHAB PARTNERS, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801132410 NPI number — VISTA REHAB PARTNERS, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA REHAB PARTNERS, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801132410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5100 ELDORADO PKWY
Provider Second Line Business Mailing Address:
#102-20D
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-6510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-572-3001
Provider Business Mailing Address Fax Number:
972-572-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 S COCKRELL HILL RD
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
DUNCANVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75137-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-572-3001
Provider Business Practice Location Address Fax Number:
972-572-3003
Provider Enumeration Date:
12/31/2012

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)