Healthcare Provider Details

I. General information

NPI: 1700824737
Provider Name (Legal Business Name): ROBERT LYNN MCCONKEY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E ORANGE ST
HOOPESTON IL
60942-1801
US

IV. Provider business mailing address

701 E ORANGE ST
HOOPESTON IL
60942-1801
US

V. Phone/Fax

Practice location:
  • Phone: 217-283-8406
  • Fax: 217-283-4101
Mailing address:
  • Phone: 217-283-8406
  • Fax: 217-283-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4657
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: