Provider Demographics
NPI:1841774767
Name:BLISS, REBECCA RAMSEY (DPT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAMSEY
Last Name:BLISS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 N ROXBORO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1888
Mailing Address - Country:US
Mailing Address - Phone:919-479-9001
Mailing Address - Fax:
Practice Address - Street 1:4214 N ROXBORO ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1888
Practice Address - Country:US
Practice Address - Phone:919-479-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist