Healthcare Provider Details

I. General information

NPI: 1043131386
Provider Name (Legal Business Name): AUTUMN RAE ROUNDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 OLIVE BLVD STE 403
SAINT LOUIS MO
63141-7894
US

IV. Provider business mailing address

10401 OLIVE BLVD STE 403
SAINT LOUIS MO
63141-7894
US

V. Phone/Fax

Practice location:
  • Phone: 557-200-2588
  • Fax:
Mailing address:
  • Phone: 557-200-2588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2026006552
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: