=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548755218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN LEIGH KONKLE DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 10/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12911 120TH AVE NE STE F120
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-3025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-305-2940
-----------------------------------------------------
Fax | 425-245-1019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 790 REMINGTON BLVD
-----------------------------------------------------
City | BOLINGBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60440-4909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-582-5526
-----------------------------------------------------
Fax | 425-245-1019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------