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Individual

MRS. REBEKAH JO GONZALES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC, LAT

Contact information

Practice address
603 N GRAND AVE, TAHLEQUAH, OK 74464-2302
(918) 557-8232
Mailing address
1249 S 103RD EAST AVE, TULSA, OK 74128-4631
(918) 557-8232

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
862
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
63472
NATIONAL ATHLETIC TRAINERS ASSOCIATION
01
862
BOARD OF MEDICAL LICENSURE AND SUPERVISION
OK
Enumeration date
05/04/2015
Last updated
05/04/2015
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