Individual
PORTIA RESNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, BCTMB
Contact information
Practice address
5707 E 24TH PL, TULSA, OK 74114
(908) 812-9320
Mailing address
5707 E 24TH PL, TULSA, OK 74114-3813
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
136
HI
2255A2300X
Athletic Trainer
25MT00067100
NJ
225700000X
Massage Therapist
12938
HI
225700000X
Massage Therapist
18KT00365100
NJ
Other
Enumeration date
08/31/2016
Last updated
08/21/2018
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