Provider Demographics
NPI:1164176350
Name:SANQUE, PAOLO ANDREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PAOLO ANDREW
Middle Name:
Last Name:SANQUE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 TOURNAMENT DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5629
Mailing Address - Country:US
Mailing Address - Phone:661-202-0566
Mailing Address - Fax:
Practice Address - Street 1:9000 MURRAY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3572
Practice Address - Country:US
Practice Address - Phone:619-369-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist