Rock Prairie Wellness Clinic, LLC
Organization Active NPI Physical Therapist · Willard, MO
NPI 1801680996 · NPPES record last updated Apr 5, 2025
Key facts
- NPI
- 1801680996
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- ROCK PRAIRIE WELLNESS CLINIC, LLC
- Practice address
- 128 N Grand Prairie Dr.
Willard, MO 65781 - Phone
- (417) 818-4752
- NPI assigned
- Apr 5, 2025
- Organization subpart
- No
Authorized official
- Name
- Dr. Zachary Robert Rust, DPT
- Title
- Owner
- Phone
- (417) 818-4752
Practitioners 3
-
Robert E Sieve, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250903002109 | MO | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5395264287 |
Receives reassigned benefits from 1 practitioner Practice locations: Willard, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
128 N Grand Prairie Dr.
Willard, MO 65781
Mailing address
7571 W Wynwood Dr
Springfield, MO 65802-8414
Phone (417) 818-4752
Other providers in Willard, MO
- Alice R. Riedel
- Erin Kathleen Rippee
- Kristen Leigh Roberts
- Damon Charles Robison
- David Gene Robison
- Samuel B Sanders
- Jill Marie Sellmeyer
- Kala Danielle Sheppard
- Susan Lynne Shikany
- Robert E Sieve
All providers in Willard, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.