Healthcare Provider Details

I. General information

NPI: 1699706085
Provider Name (Legal Business Name): RYAN CHRISTOPHER BLISS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LOOP 150 WEST, SUITE 101
BASTROP TX
78602
US

IV. Provider business mailing address

1009 N GEORGETOWN ST
ROUND ROCK TX
78664-3289
US

V. Phone/Fax

Practice location:
  • Phone: 512-303-1116
  • Fax: 512-321-1355
Mailing address:
  • Phone: 512-244-8374
  • Fax: 512-244-8371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1151072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: