Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP69819 | TX |
NPI | 1245658244 |
---|---|
Provider Name | Paul Leroy Retcofsky |
First Address | Grand Prairie, TX 75050-1257 |
Second Address | Grand Prairie, TX 75050-1257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2014 |
Last Update Date | 06/03/2016 |