Healthcare Provider Details

I. General information

NPI: 1629706882
Provider Name (Legal Business Name): LUCAS BENTON WILLIAMS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 S ARROWHEAD DR STE B
INDEPENDENCE MO
64055-6990
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 816-478-4200
  • Fax: 816-875-2597
Mailing address:
  • Phone: 913-721-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2025038444
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: