Blaze Jims Mammen

NPI #1053775379 in Allen, Texas

Provider Information

NPI Number: 1053775379
Entity Type: Individual
Name: Blaze Jims Mammen
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Enumeration Date: Apr 12, 2016
Last Updated: Apr 12, 2016

Practice Location

Address: 2035 W MCDERMOTT DR STE 460
City: Allen
State: Texas
ZIP Code: 75013-4733
Phone: (214) 289-6159

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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