Provider Demographics
NPI:1396280921
Name:GOHLKE, VANCE (LAT)
Entity type:Individual
Prefix:MR
First Name:VANCE
Middle Name:
Last Name:GOHLKE
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5131
Mailing Address - Country:US
Mailing Address - Phone:325-481-2257
Mailing Address - Fax:325-481-2023
Practice Address - Street 1:2237 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5131
Practice Address - Country:US
Practice Address - Phone:325-481-2257
Practice Address - Fax:325-481-2023
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT45882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer