Provider Demographics
NPI:1154694073
Name:ARNOLD, VICKY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
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 1:21538 HIGHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-3856
Mailing Address - Country:US
Mailing Address - Phone:479-883-6506
Mailing Address - Fax:
Practice Address - Street 1:21538 HIGHLINE RD
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-3856
Practice Address - Country:US
Practice Address - Phone:479-883-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1448225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant