Provider Demographics
NPI:1801680996
Name:ROCK PRAIRIE WELLNESS CLINIC, LLC
Entity type:Organization
Organization Name:ROCK PRAIRIE WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:417-818-4752
Mailing Address - Street 1:7571 W WYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-8414
Mailing Address - Country:US
Mailing Address - Phone:417-818-4752
Mailing Address - Fax:
Practice Address - Street 1:128 N GRAND PRAIRIE DR.
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:MO
Practice Address - Zip Code:65781
Practice Address - Country:US
Practice Address - Phone:417-818-4752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty