Provider Demographics
NPI:1851672786
Name:ARNOLD, PHYLLIS M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:M
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 1:3250 HOGAN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2830
Mailing Address - Country:US
Mailing Address - Phone:404-346-1526
Mailing Address - Fax:404-346-0729
Practice Address - Street 1:3250 HOGAN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2830
Practice Address - Country:US
Practice Address - Phone:404-346-1526
Practice Address - Fax:404-346-0729
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA000490225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant