Provider Demographics
NPI:1124341151
Name:REA, LINDA COLEEN (CMT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:COLEEN
Last Name:REA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18347 WOODLAND RIDGE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-8909
Mailing Address - Country:US
Mailing Address - Phone:616-846-3482
Mailing Address - Fax:
Practice Address - Street 1:18347 WOODLAND RIDGE DR APT 1
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8909
Practice Address - Country:US
Practice Address - Phone:616-846-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist