Provider Demographics
NPI:1760767404
Name:ARNOLD, LOIS MARIE
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:MARIE
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3137
Mailing Address - Country:US
Mailing Address - Phone:215-922-2119
Mailing Address - Fax:215-922-2119
Practice Address - Street 1:766 S 4TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3137
Practice Address - Country:US
Practice Address - Phone:215-922-2119
Practice Address - Fax:215-922-2119
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1782041744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management