MEDICARE: BLISSFUL BEING WELLNESS, LLC

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1205396355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLISSFUL BEING WELLNESS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 553
Second Line	:
City	:	WILLIAMS
State	:	OR
Zip	:	97544-0553
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 NE E ST STE A
Second Line	:
City	:	GRANTS PASS
State	:	OR
Zip	:	97526-2350
Country	:	US
Telephone Number	:	541-819-0824
Fax Number	:

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	ALIX MARMULSTEIN
Credential	:	LMT
Telephone Number	:	541-819-0824

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	04/15/2024

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Directions to “BLISSFUL BEING WELLNESS, LLC ” Practice Location

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