Provider Demographics
NPI:1053600817
Name:CONKLIN, KATHERINE JOHNSTON (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JOHNSTON
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 HEALTH PARK
Mailing Address - Street 2:SUITE 127
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4730
Mailing Address - Country:US
Mailing Address - Phone:919-845-6160
Mailing Address - Fax:919-845-6188
Practice Address - Street 1:8300 HEALTH PARK
Practice Address - Street 2:SUITE 127
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4730
Practice Address - Country:US
Practice Address - Phone:919-845-6160
Practice Address - Fax:919-845-6188
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist