Provider Demographics
NPI:1700824737
Name:MCCONKEY, ROBERT LYNN (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYNN
Last Name:MCCONKEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:HOOPESTON
Mailing Address - State:IL
Mailing Address - Zip Code:60942-1801
Mailing Address - Country:US
Mailing Address - Phone:217-283-8406
Mailing Address - Fax:217-283-4101
Practice Address - Street 1:701 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:HOOPESTON
Practice Address - State:IL
Practice Address - Zip Code:60942-1801
Practice Address - Country:US
Practice Address - Phone:217-283-8406
Practice Address - Fax:217-283-4101
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist