Provider Demographics
NPI:1902971336
Name:OLDFIELD, LYLE LOUIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:LYLE
Middle Name:LOUIS
Last Name:OLDFIELD
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 1:107 HIGHBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-7721
Mailing Address - Country:US
Mailing Address - Phone:864-855-5521
Mailing Address - Fax:864-855-5521
Practice Address - Street 1:1019 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2916
Practice Address - Country:US
Practice Address - Phone:864-654-0431
Practice Address - Fax:864-654-0799
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1913225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant