Provider Demographics
NPI:1851964126
Name:NIEKAMP, HAYDEN MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:HAYDEN
Middle Name:MATTHEW
Last Name:NIEKAMP
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 1:15071 E OUTER SPRINGER LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9048
Mailing Address - Country:US
Mailing Address - Phone:907-631-8542
Mailing Address - Fax:
Practice Address - Street 1:645 N JESSICA BROOKE CIR STE C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7333
Practice Address - Country:US
Practice Address - Phone:907-631-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist