Individual
TREK RUNDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19926 E 1140 RD, ELK CITY, OK 73644-2464
(580) 334-4948
Mailing address
19926 E 1140 RD, ELK CITY, OK 73644-2464
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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