MEDICARE: DANIELLE E ARNEY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2015003971	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5119	OTHER	MO	5119

General Provider Information

NPI Number	:	1134726250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE E ARNEY PTA

Provider Business Mailing Address
First Line	:	111 W HERITAGE DR
Second Line	:
City	:	RAYMORE
State	:	MO
Zip	:	64083-9464
Country	:	US
Telephone Number	:	816-500-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	829 SW LEMANS LN
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64082-4618
Country	:	US
Telephone Number	:	816-500-9232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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