Healthcare Provider Details

I. General information

NPI: 1891895744
Provider Name (Legal Business Name): KIMBERLY A ARNETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SIERRA COLLEGE DR STE 165
GRASS VALLEY CA
95945-5083
US

IV. Provider business mailing address

10623 BOULDER ST
NEVADA CITY CA
95959-2645
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-2320
  • Fax: 530-274-1568
Mailing address:
  • Phone: 530-274-2320
  • Fax: 530-274-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT2544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: