Individual
TRAVIS KYLE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4901 W RENO AVE, STE 500, OKLAHOMA CITY, OK 73127-6346
(405) 230-9290
(405) 230-9284
Mailing address
1110 N LEE AVE, OKLAHOMA CITY, OK 73103-2612
(405) 230-9000
(405) 230-9175
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
608
OK
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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