Individual
TOMMY GONZALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
11716 W WILKINSON ST, MAIZE, KS 67101-9007
(760) 717-7257
Mailing address
11716 W WILKINSON ST, MAIZE, KS 67101-9007
(760) 717-7257
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-01498
KS
Other
Enumeration date
06/26/2019
Last updated
08/05/2022
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