Provider Demographics
NPI:1184644940
Name:DYKSTRA, JOSEPH HENRY (ATC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:HENRY
Last Name:DYKSTRA
Suffix:
Gender:M
Credentials:ATC
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Other - Credentials:
Mailing Address - Street 1:325 LLOYD CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8119
Mailing Address - Country:US
Mailing Address - Phone:616-403-3750
Mailing Address - Fax:
Practice Address - Street 1:3195 KNIGHT WAY SE
Practice Address - Street 2:CALVIN COLLEGE SPOELHOF FIELDHOUSE COMPLEX
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4409
Practice Address - Country:US
Practice Address - Phone:616-526-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-01-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer