Provider Demographics
NPI:1225389646
Name:QUE SANCHEZ, PAUL RYAN (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:RYAN
Last Name:QUE SANCHEZ
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 1:44 GATEWICK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6488
Mailing Address - Country:US
Mailing Address - Phone:731-426-2881
Mailing Address - Fax:
Practice Address - Street 1:3035 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3007
Practice Address - Country:US
Practice Address - Phone:360-532-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60295872225100000X
TN8371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist