Healthcare Provider Details

I. General information

NPI: 1356491146
Provider Name (Legal Business Name): PARADIGM PHYSICAL THERAPY AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 CAMINO DEL LLANO
BELEN NM
87002-2727
US

IV. Provider business mailing address

535 HIGHWAY 314 SW
LOS LUNAS NM
87031-9600
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-0055
  • Fax: 505-866-0057
Mailing address:
  • Phone: 505-866-0055
  • Fax: 505-866-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2251
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number593
License Number StateNM

VIII. Authorized Official

Name: MR. DONALD JOSEPH SANCHEZ
Title or Position: PRES/OWNER
Credential: PHYSICAL THERAPIST
Phone: 505-866-0055