Provider Demographics
NPI:1093849499
Name:HASTINGS, DAMON PAUL (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:PAUL
Last Name:HASTINGS
Suffix:
Gender:M
Credentials:MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 CAVIAR ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-7738
Mailing Address - Country:US
Mailing Address - Phone:907-283-9016
Mailing Address - Fax:907-283-8438
Practice Address - Street 1:260 CAVIAR ST
Practice Address - Street 2:SUITE A
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7738
Practice Address - Country:US
Practice Address - Phone:907-283-9016
Practice Address - Fax:907-283-8438
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTC6852Medicaid
AK026530Medicare ID - Type Unspecified