Individual
MANUEL DAVID PENA ROSALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
1100 E 14TH ST, PMB 4503, ADA, OK 74820-6915
(580) 279-4655
Mailing address
1100 E 14TH ST, PMB 4503, ADA, OK 74820-6915
(580) 279-4655
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
881
OK
Other
Enumeration date
03/07/2016
Last updated
03/07/2016
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