Provider Demographics
NPI:1225109234
Name:ROBERTSON-KOSTYK, PATRICIA (DC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROBERTSON-KOSTYK
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 1:711 BETHLEHEM PIKE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-8114
Mailing Address - Country:US
Mailing Address - Phone:215-836-1766
Mailing Address - Fax:
Practice Address - Street 1:711 BETHLEHEM PIKE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-8114
Practice Address - Country:US
Practice Address - Phone:215-836-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002983L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation