Healthcare Provider Details

I. General information

NPI: 1982626032
Provider Name (Legal Business Name): MICKI LYNN WILLIAMS RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICKI LYNN BEACHLER RPT

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 JOHNSTOWN DR
ROGERSVILLE MO
65742-9366
US

IV. Provider business mailing address

PO BOX 650020
DALLAS TX
75265-0020
US

V. Phone/Fax

Practice location:
  • Phone: 417-753-7735
  • Fax: 417-753-7765
Mailing address:
  • Phone: 417-753-7735
  • Fax: 417-753-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number111525
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: