Provider Demographics
NPI:1851964126
Name:NIEKAMP, HAYDEN MATTHEW (DPT)
Entity type:Individual
Prefix:
First Name:HAYDEN
Middle Name:MATTHEW
Last Name:NIEKAMP
Suffix:
Gender:
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 1:1700 E BOGARD RD STE B203
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6570
Practice Address - Country:US
Practice Address - Phone:907-921-5088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK179258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist