Provider Demographics
NPI:1154627784
Name:CONKIN, BROOKE A (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:CONKIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW 66TH ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-8256
Mailing Address - Country:US
Mailing Address - Phone:405-840-4721
Mailing Address - Fax:
Practice Address - Street 1:200 NW 66TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-8256
Practice Address - Country:US
Practice Address - Phone:405-840-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-29
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist