Provider Demographics
NPI:1952657116
Name:CONKLIN, ALICIA DAWN (MPT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:DAWN
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 1:26639 VALLEY CENTER DR
Mailing Address - Street 2:STE. 101
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-2357
Mailing Address - Country:US
Mailing Address - Phone:661-254-1842
Mailing Address - Fax:661-254-1862
Practice Address - Street 1:26639 VALLEY CENTER DR
Practice Address - Street 2:STE. 101
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91351-2357
Practice Address - Country:US
Practice Address - Phone:661-254-1842
Practice Address - Fax:661-254-1862
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics