Provider Demographics
NPI:1548755218
Name:KONKLE, ERIN LEIGH (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LEIGH
Last Name:KONKLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:425-582-5526
Mailing Address - Fax:425-245-1019
Practice Address - Street 1:12911 120TH AVE NE STE F120
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3025
Practice Address - Country:US
Practice Address - Phone:425-305-2940
Practice Address - Fax:425-245-1019
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist