Provider Demographics
NPI:1932174695
Name:ARNOLD, BRENT LEE (PHD)
Entity Type:Individual
Prefix:PROF
First Name:BRENT
Middle Name:LEE
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 RIDDLES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-2410
Mailing Address - Country:US
Mailing Address - Phone:804-389-1817
Mailing Address - Fax:
Practice Address - Street 1:1015 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-2020
Practice Address - Country:US
Practice Address - Phone:904-828-1948
Practice Address - Fax:804-828-1946
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260001822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer