Healthcare Provider Details

I. General information

NPI: 1952007247
Provider Name (Legal Business Name): THOMAS ISAAC DYKES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1526 BRIDGEWATER LN
KINGSPORT TN
37660-4106
US

IV. Provider business mailing address

901 E MORRIS BLVD
MORRISTOWN TN
37813-2499
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-6866
  • Fax: 423-581-9679
Mailing address:
  • Phone: 423-586-6866
  • Fax: 423-581-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: