Healthcare Provider Details

I. General information

NPI: 1598291478
Provider Name (Legal Business Name): TRESTLETREE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 N BUSINESS DR SUITE 202
FAYETTEVILLE AR
72703-5204
US

IV. Provider business mailing address

3715 N BUSINESS DR SUITE 202
FAYETTEVILLE AR
72703-5204
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-0777
  • Fax: 479-582-0778
Mailing address:
  • Phone: 479-582-0777
  • Fax: 479-582-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. TED R BORGSTADT
Title or Position: PRESIDENT
Credential:
Phone: 479-582-0777