Healthcare Provider Details

I. General information

NPI: 1659296515
Provider Name (Legal Business Name): RACHEL JORGE HENDERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 GULF ST STE B
LAMAR MO
64759-1468
US

IV. Provider business mailing address

85 SW 4TH LN APT A
LAMAR MO
64759-8440
US

V. Phone/Fax

Practice location:
  • Phone: 727-458-5637
  • Fax:
Mailing address:
  • Phone: 727-458-5637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2026022504
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: