PARADIGM PHYSICAL THERAPY AND WELLNESS INC

Provider Demographics

• NPI: 1386651412
• 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: PRESIDENT/OWNER
• Authorized Official - Prefix: MR
• Authorized Official - First Name: DONALD
• Authorized Official - Middle Name: JOSEPH
• Authorized Official - Last Name: SANCHEZ
• Authorized Official - Credentials: PHYSICAL THERAPIST
• Authorized Official - Phone: 505-866-0055
• Mailing Address - Street 1: 535 HIGHWAY 314 SW
• 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: 535 US HIGHWAY 314, SW
• Practice Address - City: LOS LUNAS
• Practice Address - State: NM
• Practice Address - Zip Code: 87031
• Practice Address - Country: US
• Practice Address - Phone: 505-866-0055
• Practice Address - Fax: 505-866-0057
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: PARADIGM PHYSICAL THERAPY AND WELLNESS INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-08-02
• Last Update Date: 2013-11-26

Provider Licenses

State	License ID	Taxonomies
NM	593	225100000X, 261QP2000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NM	1215238910	Other	PATRICK VIGIL NPI
NM	000Q0406	Medicaid
NM	1356491146	Other	BELEN FACILITY NPI
NM	1326062423	Other	STEVE WAGHORN NPI#
NM	DC4165	Other	GROUP RR MEDICARE
NM	1013214857	Other	VALERIE GUTIERREZ, PT
NM	1417971508	Other	DONALD SANCHEZ NPI#
NM	149775860	Other	MARIE VALDEZ, PT NPI#
NM	1245380039	Other	BERNAILLO FACILITY NPI#
NM	1245380039	Other	BERNAILLO FACILITY NPI#