Provider Demographics
NPI:1326851551
Name:BHAUMIK, ANIRUDDHA
Entity type:Individual
Prefix:
First Name:ANIRUDDHA
Middle Name:
Last Name:BHAUMIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ATLAS LN
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:TX
Mailing Address - Zip Code:75407-1287
Mailing Address - Country:US
Mailing Address - Phone:913-820-3044
Mailing Address - Fax:
Practice Address - Street 1:1330 W CAMPBELL RD STE 110
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2838
Practice Address - Country:US
Practice Address - Phone:913-820-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT143791225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist