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General NPI Number Information
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NPI Number | 1487506689
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Entity Type | Individual
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Provider Name | TREVOR JOSEPH HALBACH
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Gender | Male
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 1809 E 13TH ST
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City | TULSA
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State | OK
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Zip | 74104-4419
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Country | US
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Telephone | 918-579-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E JUNEAU PL
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City | BROKEN ARROW
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State | OK
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Zip | 74012-8248
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6502
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License Number State | OK
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