Healthcare Provider Details

I. General information

NPI: 1386651412
Provider Name (Legal Business Name): PARADIGM PHYSICAL THERAPY AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 US HIGHWAY 314, SW
LOS LUNAS NM
87031
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 Number593
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: PRESIDENT/OWNER
Credential: PHYSICAL THERAPIST
Phone: 505-866-0055