Provider Demographics
NPI:1609120039
Name:CONKLIN, TRICIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:ANASTASIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:1 NARDONE PL
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3514
Practice Address - Country:US
Practice Address - Phone:201-792-3840
Practice Address - Fax:201-792-7948
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01485900225100000X
NY035700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist