Healthcare Provider Details

I. General information

NPI: 1245380039
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: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S. CAMINO DEL PUEBLO, SUITE G
BERNALILLO NM
87004-5925
US

IV. Provider business mailing address

535 US HIGHWAY 314
LOS LUNAS NM
87031-9600
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-2447
  • Fax: 505-771-2360
Mailing address:
  • Phone: 505-866-0055
  • Fax: 505-866-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2646
License Number StateNM

VIII. Authorized Official

Name: MR. DONALD J. SANCHEZ
Title or Position: OWNER / PRESIDENT
Credential: P.T.
Phone: 505-866-0055