MEDICARE: PARADIGM PHYSICAL THERAPY AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0145	NM

General Provider Information

NPI Number	:	1679090633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARADIGM PHYSICAL THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	535 HWY 314 SW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-9600
Country	:	US
Telephone Number	:	505-866-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 LAS ESTANCIAS CT SW STE 102
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87121-5513
Country	:	US
Telephone Number	:	505-866-0055
Fax Number	:	505-866-0057

Authorized Official
Title or Position	:	PRESIDENT/OWNER/PT
Name	:	MR. DONALD SANCHEZ
Credential	:
Telephone Number	:	505-866-0055

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	08/29/2017

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