Healthcare Provider Details

I. General information

NPI: 1548755218
Provider Name (Legal Business Name): ERIN LEIGH KONKLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12911 120TH AVE NE STE F120
KIRKLAND WA
98034-3025
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 425-305-2940
  • Fax: 425-245-1019
Mailing address:
  • Phone: 425-582-5526
  • Fax: 425-245-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: