Provider Demographics
NPI:1679111850
Name:RETEY, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:RETEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 HIGHWAY 17 UNIT D5
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6431
Mailing Address - Country:US
Mailing Address - Phone:843-357-0143
Mailing Address - Fax:
Practice Address - Street 1:4450 HIGHWAY 17 UNIT D5
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6431
Practice Address - Country:US
Practice Address - Phone:843-357-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0527237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist