NPI 1154708626

Jordan Gonzales, ATCLAT

Practitioner Athletic Trainer Tahlequah, OK

Practice location

Address: 603 N Grand Ave, Tahlequah, OK 74464-2302
Phone: (918) 444-3921
Mailing address: 1249 S 103rd East Ave, Tulsa, OK 74128-4631

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence 830 (OK)

Other Specialist/Technologist providers in Oklahoma →

Registry record

NPI: 1154708626
Entity type: Individual
Sex (as registered): Male
NPI issued: 4 May 2015
Record last updated: 4 May 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.