Provider Demographics
NPI:1508310962
Name:ARNOLD, LOGAN BLAINE (PT)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:BLAINE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 COMMERCE DR
Mailing Address - Street 2:STE A
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-1495
Mailing Address - Country:US
Mailing Address - Phone:870-248-0800
Mailing Address - Fax:870-248-0802
Practice Address - Street 1:1415 COMMERCE DR
Practice Address - Street 2:STE A
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-1495
Practice Address - Country:US
Practice Address - Phone:870-248-0800
Practice Address - Fax:870-248-0802
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist