Healthcare Provider Details

I. General information

NPI: 1194635227
Provider Name (Legal Business Name): WILLIAM KENNETH LAWRENCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 MCKENZIE RD STE A
SPRINGDALE AR
72762-0870
US

IV. Provider business mailing address

4000 S DIXIELAND RD APT AA5
ROGERS AR
72758-1828
US

V. Phone/Fax

Practice location:
  • Phone: 479-250-4014
  • Fax:
Mailing address:
  • Phone: 479-264-8823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5949
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: