Healthcare Provider Details

I. General information

NPI: 1093634180
Provider Name (Legal Business Name): ALEXANDER DALLAS DETTMERS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 S THOMPSON ST STE B
SPRINGDALE AR
72764-2551
US

IV. Provider business mailing address

4915 S THOMPSON ST STE B
SPRINGDALE AR
72764-2551
US

V. Phone/Fax

Practice location:
  • Phone: 307-274-5146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5830
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: