Healthcare Provider Details

I. General information

NPI: 1225713407
Provider Name (Legal Business Name): MEGAN DYKEMA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N COLLEGE AVE
FAYETTEVILLE AR
72703-1908
US

IV. Provider business mailing address

4301 W MARKHAM ST # 783
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 479-713-8630
  • Fax: 479-713-8639
Mailing address:
  • Phone: 501-686-8000
  • Fax: 501-526-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5122
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: