Individual
TEA PEGUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1414 E 39TH ST APT 146, TULSA, OK 74105-3388
(720) 557-2947
Mailing address
522 W CASHMERE RD, BOISE, ID 83702-1622
(720) 557-2947
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
5871768
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000057995
BOARD OF CERTIFICATION
—
Enumeration date
12/05/2023
Last updated
08/16/2025
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