MEDICARE: BLISS PELVIC HEALTH

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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1114532074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISS PELVIC HEALTH

Provider Business Mailing Address
First Line	:	2640 CYPRESS RIDGE BLVD STE 103
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6318
Country	:	US
Telephone Number	:	813-993-4212
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 CYPRESS RIDGE BLVD STE 103
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6318
Country	:	US
Telephone Number	:	813-993-4212
Fax Number	:	813-738-1562

Authorized Official
Title or Position	:	MANAGER
Name	:	DWAGNE J HASKINS
Credential	:	DPT
Telephone Number	:	813-993-4212

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	03/27/2024

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Directions to “BLISS PELVIC HEALTH ” Practice Location

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