Healthcare Provider Details

I. General information

NPI: 1942114301
Provider Name (Legal Business Name): MALLORY KATE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 18TH ST
HERMANN MO
65041-1547
US

IV. Provider business mailing address

509 W 18TH ST
HERMANN MO
65041-1547
US

V. Phone/Fax

Practice location:
  • Phone: 573-486-2154
  • Fax: 573-486-2250
Mailing address:
  • Phone: 573-486-2154
  • Fax: 573-486-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2026008576
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: