Provider Demographics
NPI:1619637691
Name:ARNOLD, ALLISON ANNE (LMT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANNE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20907 BALD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9402
Mailing Address - Country:US
Mailing Address - Phone:301-357-0582
Mailing Address - Fax:
Practice Address - Street 1:20907 BALD RIDGE DR
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9402
Practice Address - Country:US
Practice Address - Phone:301-357-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist