MEDICARE: SALLY BLISS HOLLON LMT, NMT, RYT

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	282499-00

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	282499-00	OTHER		NCBTMB

General Provider Information

NPI Number	:	1366059537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY BLISS HOLLON LMT, NMT, RYT

Provider Business Mailing Address
First Line	:	11568 BRANCHWOOD DR
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-4902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	557 N MOBILE ST
Second Line	:
City	:	FAIRHOPE
State	:	AL
Zip	:	36532-2609
Country	:	US
Telephone Number	:	404-822-4469
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	09/30/2020

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Directions to “ SALLY BLISS HOLLON LMT, NMT, RYT” Practice Location

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