Active NPI
Blake Williams
- Physical Therapist
- Rolla, MO
National Provider Identifier
1528988805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2026034853
- Practice address
- 603 S Bishop Ave Ste B
Rolla, MO 65401-4320 - Phone
- (573) 202-6537
- Fax
- (573) 426-7001
- NPI assigned
- Jul 17, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2026034853 | MO | Primary |
Addresses
Primary practice location
603 S Bishop Ave Ste B
Rolla, MO 65401-4320
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2026
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
120 Liberty Pkwy Apt
Bo3
Saint Robert, MO 65584-4871
2122 York Rd
Suite 300
Oak Brook, IL 60523-1981
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784764800000",
"number": "1528988805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2122 YORK RD STE 300",
"city": "OAK BROOK",
"state": "IL",
"postal_code": "605231925",
"telephone_number": "630-575-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "603 S BISHOP AVE STE B",
"city": "ROLLA",
"state": "MO",
"postal_code": "654014320",
"telephone_number": "573-202-6537",
"fax_number": "573-426-7001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "BLAKE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-07-17",
"last_updated": "2026-07-23",
"certification_date": "2026-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "MO",
"license": "2026034853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.