Provider Demographics
NPI:1780268904
Name:MCCONKEY, PRESLEY KAYLN (PTA)
Entity type:Individual
Prefix:MRS
First Name:PRESLEY
Middle Name:KAYLN
Last Name:MCCONKEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:61432-0253
Mailing Address - Country:US
Mailing Address - Phone:309-202-4782
Mailing Address - Fax:
Practice Address - Street 1:61 E SIDE SQ
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2603
Practice Address - Country:US
Practice Address - Phone:309-649-1572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160007989208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation