Healthcare Provider Details

I. General information

NPI: 1528770187
Provider Name (Legal Business Name): CALLIE ROSE LINN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE ROSE LINN DPT

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 W LANCASHIRE BLVD
BELLA VISTA AR
72715-3027
US

IV. Provider business mailing address

600 PACIFIC AVE
BENTONVILLE AR
72713-4075
US

V. Phone/Fax

Practice location:
  • Phone: 479-876-6668
  • Fax:
Mailing address:
  • Phone: 318-680-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5243
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: