Provider Demographics
NPI:1982796785
Name:KONKLER, CATHY J (PT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:KONKLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11177 LAMBS LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9779
Mailing Address - Country:US
Mailing Address - Phone:740-763-0408
Mailing Address - Fax:
Practice Address - Street 1:159 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5007
Practice Address - Country:US
Practice Address - Phone:740-345-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133644Medicaid
OH0778994Medicare PIN
OH0778991Medicare PIN
OH0133644Medicaid