Provider Demographics
NPI:1760099139
Name:VANDYKE, PATRICK J (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:VANDYKE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RAVINE ST
Mailing Address - Street 2:
Mailing Address - City:MUNHALL
Mailing Address - State:PA
Mailing Address - Zip Code:15120-2144
Mailing Address - Country:US
Mailing Address - Phone:412-491-8004
Mailing Address - Fax:
Practice Address - Street 1:1301 RAVINE ST
Practice Address - Street 2:
Practice Address - City:MUNHALL
Practice Address - State:PA
Practice Address - Zip Code:15120-2144
Practice Address - Country:US
Practice Address - Phone:412-491-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG010652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist