Provider Demographics
NPI:1902639834
Name:CONKIN PELVIC HEALTH LLC
Entity type:Organization
Organization Name:CONKIN PELVIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-888-1852
Mailing Address - Street 1:1616 E 19TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-6628
Mailing Address - Country:US
Mailing Address - Phone:405-888-1852
Mailing Address - Fax:
Practice Address - Street 1:1616 E 19TH ST STE 404
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6628
Practice Address - Country:US
Practice Address - Phone:405-888-1852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty