MEDICARE: ANGELICA RAIN LAVENDER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT148473	TX

General Provider Information

NPI Number	:	1215889951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA RAIN LAVENDER

Provider Business Mailing Address
First Line	:	2400 W RATHGEBER RD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76310-7926
Country	:	US
Telephone Number	:	580-704-9169
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 8TH ST STE 801
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-6857
Country	:	US
Telephone Number	:	580-704-9169
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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Directions to “ ANGELICA RAIN LAVENDER ” Practice Location

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