Provider Demographics
NPI:1972068765
Name:OAKS, JAMES CLYDE (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CLYDE
Last Name:OAKS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37665-1724
Mailing Address - Country:US
Mailing Address - Phone:423-579-9680
Mailing Address - Fax:
Practice Address - Street 1:2421 NORTH JOHN B DENNIS
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37665
Practice Address - Country:US
Practice Address - Phone:423-288-4988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4968225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty