Healthcare Provider Details

I. General information

NPI: 1487506689
Provider Name (Legal Business Name): TREVOR JOSEPH HALBACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 E 13TH ST
TULSA OK
74104-4419
US

IV. Provider business mailing address

214 E JUNEAU PL
BROKEN ARROW OK
74012-8248
US

V. Phone/Fax

Practice location:
  • Phone: 918-579-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6502
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: