=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346046596
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRESTON ARNOLD DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2025
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3059 CHAMPION WAY STE 400
-----------------------------------------------------
City | MELISSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75454-2795
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-885-8671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2224 HOPPER LN
-----------------------------------------------------
City | MELISSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75454-9936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-512-3992
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1405892
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------