Provider Demographics
NPI:1417100454
Name:TREITLER, LINDA KAY (RN, MMT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KAY
Last Name:TREITLER
Suffix:
Gender:F
Credentials:RN, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:HINDSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72738-9447
Mailing Address - Country:US
Mailing Address - Phone:479-587-1700
Mailing Address - Fax:479-587-1366
Practice Address - Street 1:3232 N NORTHHILLS BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4005
Practice Address - Country:US
Practice Address - Phone:479-587-1700
Practice Address - Fax:479-587-1633
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR32595163W00000X, 163WM1400X
AR2759173C00000X, 225500000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse
No173C00000XOther Service ProvidersReflexologist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR2759OtherMASTER MASSAGE THERAPIST LICENSE
ARR32595OtherNURSING LICENSE NUMBER