Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 0126001733 | VA |
NPI | 1326485814 |
---|---|
Provider Name | Tracy Oakes |
First Address | Hampton, VA 23666-5963 |
Second Address | Newport News, VA 23607-1852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 24/05/2013 |