Provider Demographics
NPI:1245380039
Name:PARADIGM PHYSICAL THERAPY AND WELLNESS INC
Entity Type:Organization
Organization Name:PARADIGM PHYSICAL THERAPY AND WELLNESS INC
Other - Org Name:LOS LUNAS PHYSICAL THERAPY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-866-0055
Mailing Address - Street 1:535 US HIGHWAY 314
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9600
Mailing Address - Country:US
Mailing Address - Phone:505-866-0055
Mailing Address - Fax:505-866-0057
Practice Address - Street 1:240 S. CAMINO DEL PUEBLO, SUITE G
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5925
Practice Address - Country:US
Practice Address - Phone:505-771-2447
Practice Address - Fax:505-771-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2646261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1417971508OtherDONALD SANCHEZ NPI
NM1326062423OtherSTEVE WAGHORN NPI
NM1215238910OtherPATRICK VIGIL NPI
NM1356491146OtherBELEN FACILITY NPI
NMDC4165OtherGROUP RR MEDICARE
NM1013214857OtherVALERIE GUTIERREZ, DPT
NM000Q0406Medicaid
NM1558526467OtherHAROLD MORGAN NPI
NM1386651412OtherLOS LUNAS FACILITY NPI
NM1326062423OtherSTEVE WAGHORN NPI