Individual
MR. CHARLESTON GAVIN OATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5719 RAINBOW RD, COVE, TX 77523-5071
(501) 333-4040
Mailing address
5719 RAINBOW RD, COVE, TX 77523-5071
(501) 333-4040
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2141867
TX
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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