Provider Demographics
NPI:1376732750
Name:DYKSTRA, DANA LOU (PT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LOU
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4154
Mailing Address - Country:US
Mailing Address - Phone:605-224-8628
Mailing Address - Fax:605-224-6948
Practice Address - Street 1:950 E PARK ST
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4154
Practice Address - Country:US
Practice Address - Phone:605-224-8628
Practice Address - Fax:605-224-6948
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03222251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics