Provider Demographics
NPI:1912204728
Name:CONKLIN, SUSAN M (MPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7759
Mailing Address - Fax:
Practice Address - Street 1:659 S SALISBURY BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5458
Practice Address - Country:US
Practice Address - Phone:410-831-3226
Practice Address - Fax:410-572-4041
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist