Provider Demographics
NPI:1245658244
Name:RETCOFSKY, PAUL LEROY (ATP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LEROY
Last Name:RETCOFSKY
Suffix:
Gender:M
Credentials:ATP
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Mailing Address - Street 1:1340 POST AND PADDOCK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-1257
Mailing Address - Country:US
Mailing Address - Phone:972-647-0111
Mailing Address - Fax:972-647-0040
Practice Address - Street 1:1340 POST AND PADDOCK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1257
Practice Address - Country:US
Practice Address - Phone:972-647-0111
Practice Address - Fax:972-647-0040
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2016-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXATP69819225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner