Basic Information
Provider Information
NPI: 1881017432
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARNOLD
FirstName: DANIEL
MiddleName: CORDELL
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1848 WILTSEY RD SE APT 315
Address2:  
City: SALEM
State: OR
PostalCode: 973069631
CountryCode: US
TelephoneNumber: 5039494111
FaxNumber:  
Practice Location
Address1: 6250 COMMERCIAL ST SE
Address2:  
City: SALEM
State: OR
PostalCode: 973061333
CountryCode: US
TelephoneNumber: 5034851666
FaxNumber: 5035816867
Other Information
ProviderEnumerationDate: 01/31/2014
LastUpdateDate: 01/31/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X60476ORY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


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