Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC002983L | PA |
NPI | 1225109234 |
---|---|
Provider Name | Patricia Robertson-Kostyk |
First Address | Glenside, PA 19038-8114 |
Second Address | Glenside, PA 19038-8114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 07/01/2015 |