Provider Demographics
NPI:1053645994
Name:COLASURDO, PATRICIA (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:COLASURDO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-1561
Mailing Address - Country:US
Mailing Address - Phone:610-282-2525
Mailing Address - Fax:610-282-3372
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-1561
Practice Address - Country:US
Practice Address - Phone:610-282-2525
Practice Address - Fax:610-282-3372
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007129L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor