=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215582499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLISS PHYSICAL THERAPY AND WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2019
-----------------------------------------------------
Last Update Date | 08/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1404 SILVERSPOT CT
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21703-5986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-340-5079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1404 SILVERSPOT CT
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21703-5986
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-340-5079
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KARYN ANNE FARRAR-BLISS
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 443-340-5079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------