Provider Demographics
NPI:1861684409
Name:ARNOLD, SHIRLEY (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
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:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-8010
Mailing Address - Country:US
Mailing Address - Phone:850-682-7466
Mailing Address - Fax:850-682-6591
Practice Address - Street 1:577 BROOKMEADE DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-6029
Practice Address - Country:US
Practice Address - Phone:850-682-7466
Practice Address - Fax:850-682-6591
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18906225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA18906OtherSTATE LICENSE