Provider Demographics
NPI:1023385192
Name:DYKEMA, NATHAN EDWARD (DPT)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:EDWARD
Last Name:DYKEMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 CHICAGO DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3004
Mailing Address - Country:US
Mailing Address - Phone:616-796-6781
Mailing Address - Fax:616-796-6782
Practice Address - Street 1:730 CHICAGO DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3004
Practice Address - Country:US
Practice Address - Phone:616-796-6781
Practice Address - Fax:616-796-6782
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010157682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic