Provider Demographics
NPI:1093046393
Name:PAUL, IAN CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:CHRISTOPHER
Last Name:PAUL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7100
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-7100
Mailing Address - Country:US
Mailing Address - Phone:575-257-5820
Mailing Address - Fax:
Practice Address - Street 1:147 MESCALERO TRL
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6090
Practice Address - Country:US
Practice Address - Phone:575-257-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist