Provider Demographics
NPI:1497363048
Name:ARNOLD, MARILYN A (PTA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 IOWA DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2634
Mailing Address - Country:US
Mailing Address - Phone:321-591-6950
Mailing Address - Fax:
Practice Address - Street 1:1395 N COURTENAY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4474
Practice Address - Country:US
Practice Address - Phone:321-986-8812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30072225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant