Provider Demographics
NPI:1841611134
Name:EBLEN, JAMES ARNOLD JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ARNOLD
Last Name:EBLEN
Suffix:JR
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 1:12556 KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-7259
Mailing Address - Country:US
Mailing Address - Phone:913-683-3480
Mailing Address - Fax:
Practice Address - Street 1:12556 KNOLLWOOD DR
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-7259
Practice Address - Country:US
Practice Address - Phone:913-683-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant