Provider Demographics
NPI:1225640402
Name:RAINBOLT, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:RAINBOLT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 FOUNTAIN GRASS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4126
Mailing Address - Country:US
Mailing Address - Phone:217-801-1891
Mailing Address - Fax:
Practice Address - Street 1:7873 HIGHWAY N
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-6704
Practice Address - Country:US
Practice Address - Phone:636-229-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist