Provider Demographics
NPI:1861858714
Name:CONKLIN, JACLYN MARGUERITE (DPT)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARGUERITE
Last Name:CONKLIN
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 1:2000 EMPIRE BLVD
Mailing Address - Street 2:BLDG 2
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1957
Mailing Address - Country:US
Mailing Address - Phone:585-671-1030
Mailing Address - Fax:585-671-1991
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:BLDG 2
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-1030
Practice Address - Fax:585-671-1991
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist