Healthcare Provider Details

I. General information

NPI: 1972414837
Provider Name (Legal Business Name): AUTUMN MARIE RAINEY LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 S MAIN ST
LOBELVILLE TN
37097-3276
US

IV. Provider business mailing address

214 BROOKLYN AVE
LINDEN TN
37096-3319
US

V. Phone/Fax

Practice location:
  • Phone: 615-475-8293
  • Fax:
Mailing address:
  • Phone: 615-475-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15529
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: