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General NPI Number Information
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NPI Number | 1609377092
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Entity Type | Individual
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Provider Name | MARK RUTOWSKI
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Gender | Male
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 06/25/2024
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Provider Practice Location Address
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Address Line | 3017 MEDLIN DR
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City | ARLINGTON
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State | TX
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Zip | 76015-2336
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Country | US
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Telephone | 248-299-0030
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Fax |
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Provider Business Mailing Address
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Address Line | 2088 HOLT WAY
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City | GRAPEVINE
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State | TX
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Zip | 76051-3009
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Country | US
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Telephone | 826-430-8152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7123
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License Number State | TX
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