Active NPI
Blaze Jims Mammen
- Physical Therapist
- Allen, TX
National Provider Identifier
1053775379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1270540
- Practice address
- 2035 W McDermott Dr Ste 460
Allen, TX 75013-4733 - Phone
- (214) 289-6159
- NPI assigned
- Apr 12, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1270540 | TX | Primary |
Addresses
Primary practice location
2035 W McDermott Dr Ste 460
Allen, TX 75013-4733
Mailing address
305 NE Loop 820
Business Tower 1 ,Suite 200
Hurst, TX 76053-7209
Phone (817) 292-8787
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1270540 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1460419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460419200000",
"number": "1053775379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 NE LOOP 820",
"address_2": "BUSINESS TOWER 1 ,SUITE 200",
"city": "HURST",
"state": "TX",
"postal_code": "760537209",
"telephone_number": "817-292-8787",
"fax_number": "817-789-6849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2035 W MCDERMOTT DR STE 460",
"city": "ALLEN",
"state": "TX",
"postal_code": "750134733",
"telephone_number": "214-289-6159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JIMS MAMMEN",
"first_name": "BLAZE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-12",
"last_updated": "2016-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1270540",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.