Healthcare Provider Details

I. General information

NPI: 1982531273
Provider Name (Legal Business Name): RACHAEL AMANDA DURNELL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 OLEATHA AVE APT A
SAINT LOUIS MO
63139-1301
US

IV. Provider business mailing address

8000 BONHOMME AVE STE 218C
CLAYTON MO
63105-3468
US

V. Phone/Fax

Practice location:
  • Phone: 314-623-7365
  • Fax:
Mailing address:
  • Phone: 314-623-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2010007309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: