Basic Information
| Provider Information | |||||||||
| NPI: | 1235632670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNOLD | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | LOUIS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3126 WILLS ST SE | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300804466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048221962 | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 E BROADWAY AVE # 100 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 830018640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077391864 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2018 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011675 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.