Healthcare Provider Details

I. General information

NPI: 1366978553
Provider Name (Legal Business Name): SETH J ARNOLD PTA, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2017
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 REDWOOD ST
ANCHORAGE AK
99508-4212
US

IV. Provider business mailing address

4333 SAN ERNESTO AVE UNIT 115
ANCHORAGE AK
99508-2837
US

V. Phone/Fax

Practice location:
  • Phone: 907-917-0818
  • Fax: 907-339-4858
Mailing address:
  • Phone: 907-884-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number106943
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number101564
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: