Provider Demographics
NPI:1356491146
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:PRES/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:505-866-0055
Mailing Address - Street 1:535 HIGHWAY 314 SW
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 1:1220 CAMINO DEL LLANO
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-2727
Practice Address - Country:US
Practice Address - Phone:505-866-0055
Practice Address - Fax:505-866-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM593225100000X
NM2251261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Q0406Medicaid
NM1013214857OtherVALERIE GUTIERREZ, DPT
NM1326062423OtherSTEVE WAGHORN, PT
NM1417971508OtherDONALD SANCHEZ' NPI
NM1215238910OtherPATRICK VIGIL, DPT
NM1386651412OtherLOS LUNAS FACILITY NPI
NMDC4165OtherGROUP RR MEDICARE
NM1245380039OtherBERNALILLO FACILITY NPI
NM1013214857OtherVALERIE GUTIERREZ, DPT