Provider Demographics
NPI:1609321512
Name:SANCHEZ, LUIS ALBERTO (PTA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ALBERTO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 JOHN KNOX DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9662
Mailing Address - Country:US
Mailing Address - Phone:336-389-4059
Mailing Address - Fax:336-668-4911
Practice Address - Street 1:1575 JOHN KNOX DR
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:NC
Practice Address - Zip Code:27235-9662
Practice Address - Country:US
Practice Address - Phone:336-389-4059
Practice Address - Fax:336-668-4911
Is Sole Proprietor?:No
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant