Healthcare Provider Details

I. General information

NPI: 1043144611
Provider Name (Legal Business Name): BACK TO BLISS MASSAGE & BODYWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BECK LN
LAFAYETTE IN
47909-2908
US

IV. Provider business mailing address

3708 SWEET VALLEY LN APT A3
LAFAYETTE IN
47909-8308
US

V. Phone/Fax

Practice location:
  • Phone: 765-262-2816
  • Fax:
Mailing address:
  • Phone: 765-262-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAWN JONES-GRAHAM
Title or Position: OWNER & LICENSED MASSAGE THERAPIST
Credential: LMT
Phone: 765-262-2816