Provider Demographics
NPI:1326331232
Name:BLUEPRINT TO HEALTHCARE
Entity Type:Organization
Organization Name:BLUEPRINT TO HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GUMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-514-8766
Mailing Address - Street 1:PO BOX 632225
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:305 CIMARRON TRL STE 180
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4502
Practice Address - Country:US
Practice Address - Phone:972-401-8800
Practice Address - Fax:972-401-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9102208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty