Individual
GRACE PONGNEA GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1608 ROCK HOLLOW LOOP, BRYAN, TX 77807-2360
(210) 326-9956
Mailing address
1093 E COUNTY ROAD 5718, NATALIA, TX 78059-2712
(210) 326-9956
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/30/2021
Last updated
07/30/2021
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