| Doctor Name: | BLAZE JIMS MAMMEN |
| NPI Number: | 1053775379 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1270540 |
| Business Practice Address: | 2035 W Mcdermott Dr Ste 460 Allen, TX - 750134733 |
| Business Phone Number: | 2142896159 |
| Business Fax Number: | |
| Mailing Address: | 305 Ne Loop 820, Business Tower 1 ,suite 200 HURST |
| State: | TX |
| Postal Code: | 760537209 |
| Phone Number: | 8172928787 |
| Fax Number: | 8177896849 |
| NPI Enumeration Date: | 04/12/2016 |
| NPI Last Update Date: | 04/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 1270540 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |