Ethan Royce Dickeson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

824 N Tyler St
Little Rock, AR 72205-3535

Phone

(501) 664-2691

NPI assigned

Jul 1, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1437994308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 MILDRED ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720346178",
            "telephone_number": "501-206-4113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 N TYLER ST",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722053535",
            "telephone_number": "501-664-2691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKESON",
        "first_name": "ETHAN",
        "middle_name": "ROYCE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jimmy Don Dickerson
• Myia Dickerson, DO
• Shunta L Dickerson
• Taiwan Dickerson, MHPP
• Tara Michelle Dickerson
• Grace Ann Dickey
• John R. E. Dickins, MD
• Leslie Hall Dickinson, D.D.S.
• Dickson Orthopaedic Centers
• Jeffrey Douglas Dickson, M.D.

• Physical Therapist in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.