Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2707 | SC |
NPI | 1003186404 |
---|---|
Provider Name | Jordan Brown Oates |
First Address | Simpsonville, SC 29680-3543 |
Second Address | Laurens, SC 29360-2672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2012 |
Last Update Date | 09/05/2013 |