Basic Information
| Provider Information | |||||||||
| NPI: | 1578868352 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARNTSON | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 50469 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307780200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 751 OLD RICHARDSON HWY | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997017813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074554401 | ||||||||
| FaxNumber: | 9074554402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2011 | ||||||||
| LastUpdateDate: | 01/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2299 | AK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 2299 | 01 | AK | LIC # | OTHER |